Question Intern is Hospital rounding with Doctor

jrp712

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Hello, if a teaching resident is rounding with Physicians and is writing their notes does it need to document that on the notes before Physician signs the note?

Also, if the NP is doing the hospital rounding does the NP sign the notes?
I've been trying to locate it on the Medicare guidelines but having problems finding it.

Looking for any information available for guidance.
Thank you.
 

ccallycat

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I'm not sure about Medicare guidelines, but the residents that dictate reports for my providers consults or progress notes will notate at the beginning of the note "dictated for Dr. Smith". They also electronically sign the note and then my provider will review, add any additional addendums as needed, and electronically sign. I think I might have also seen times where my provider will say in his addendum "report dictated by resident, but was examined by me" something like that, but majority of the time the residents will state the doctor who they are dictating for.

The same goes for our PA, if she sees a patient she will dictate in her notes "seen with Dr. Smith" she will sign first then my provider will sign and I will bill under the provider if he's present for visit. If she is the only one who sees the patient, or says discussed with Dr. Smith, then its just her signature and I bill under her.
 

csperoni

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Here are the Medicare guidelines about teaching physicians:
Summary - if resident and teaching physician rounding together, the resident may document the note. The teaching physician should add an attestation that they were present and performed services and use modifier -GC. Usually, the hospital legal team will determine what exact wording they want and there will be a macro in the EHR system. The resident & teaching physician may also see the patient at different times the same day (do not need to round together). The teaching physician attestation should specify this. The teaching physician may not just co-sign a note with no indication they were personally present and expect to bill.

NP (or PA). This is very different than teaching physicians. NPP claims for hospital services may be billed under Split/Shared rules https://www.cms.gov/outreach-and-ed.../downloads/eval-mgmt-serv-guide-icn006764.pdf (see top of page 21)
1) the NPP cannot be the "teaching physician" of a resident.
2) NPP services may either be signed/billed under the NPP if not seen by physician that day OR under billed under the physician if the physician also saw/examined patient same day under the split/shared.
3) I want to specify this is only for hospital services; office services do not fall under Split/Shared and typically fall under Incident To rules (if carrier follows incident to).
 
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