Wiki Primary Care Exception Rule

[kishonb25]

I work in an OBgyn office that is an outpatient clinic in a teaching hospital. Under the Primary care exception rule, Residents can see patients with the close, but not direct supervision of the Teaching Provider. There can only be up to 4 Residents at once, the Teaching Provider must be available at all times and the Teaching Provider must include an addendum describing their role in the patient's care. However, because the Residents are not directly credentialed with any insurance company, who's name is on the bill? The Residents? The Teaching Provider?
My current understanding is that Resident cannot bill under their own names...

 

[brewsters]

Check your contracts to ensure the payor recognizes the primary care exception. I don't have much experience outside of CMS's guidance on the primary care exception. Services provided under the primary care exception are reported under the teaching physician's NPI with modifier GE (the physician that is adding the attestation).