Residents billing based on time in Office setting 2021

[metromedical]

I need to verify that residents CANNOT bill based on time begininng with the new guidelines in 2021 in an office based setting (teaching physician rules). Is there a link to confirm this
for my teaching physicians? Thank you

 

[csperoni]

For 2021 outpatient E/M, it is time spent by the "physician or other qualified health care professional." Residents are not qualified health care professionals and rather considered clinical staff. There is a Primary Care Exception which includes resident's face to face time.

Specifically, my MAC, NGS has issued this: full document click here
Question: When level-setting a service based on time in the office or outpatient setting, is time spent alone by a resident added to time spent by the teaching physician with counted in total time spent?
Answer: When level-setting a service based on time, only time spent by an enrolled Medicare provider who is permitted to perform and bill for an E/M service is counted toward total time spent. This limits counted time to time spent by a physician or NPP (PA or NPP). Clinical staff time cannot be counted and, in this context, the resident’s time would be considered as clinical staff time and is not counted. There is an exception to this rule in the PCE setting, described in the next FAQ below.

Question: When level-setting a service based on time in a Primary Care Exception outpatient setting, is time spent alone by a resident added to time spent by the teaching physician counted in total time spent?
Answer: In a PCE setting, a teaching physician supervises up to four qualified residents and must remain available to the residents throughout the clinic session to see a patient personally at a resident’s request. Residents are permitted to see patients without the direct personal presence of the teaching physician and must review the plan of care for each patient with the teaching physician before the close of the clinic session. In the PCE setting only, total time for level-setting a visit includes the teaching physician’s time (in seeing the patient and/or reviewing the plan of care) and the resident’s time during his/her F2F encounter with the patient.

 

[metromedical]

Thank you very much. I spent hours looking for this!

 

[arsims]

I also have a question? Did CMS guidelines change pertaining to residents seeing level 4 and 5. I was looking on CMS and could find nothing on the change that supposedly happen in Mar 1 2020

 

[SWASH3]

Arsims, you asked....Did CMS guidelines change pertaining to residents seeing level 4 and 5. I was looking on CMS and could find nothing on the change that supposedly happen in Mar 1 2020?
Please see this link on the MLN MATTERS SE20011: https://www.cms.gov/files/document/se20011.pdf
Go to the bottom of page 9 and it continues on page 10