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Fellow vs Resident

  1. #1
    Default Fellow vs Resident
    Medical Coding Books
    Can a Fellow bill under his/her own NPI or are they treated like a Resident requiring a Supervising MD?

    Thanks, Connie

  2. #2
    A fellow is considered a resident according to teaching physician guidelines.

    According to CMS:
    An Intern or Resident is an individual who participates in an approved Graduate Medical Education (GME) Program or a physician who is not in an approved GME Program but who is authorized to practice only in a hospital setting (e.g., has a temporary or restricted license or is an unlicensed graduate of a foreign medical school). Also included in this definition are interns, residents, and fellows in GME Programs recognized as approved for purposes of direct GME and IME payments made by Fiscal Inter-mediaries or A/B Medicare Administrative Contractors. Receiving a staff or faculty appointment, participating in a fellowship, or whether a hospital includes the physician in its full-time equivalency count of residents does not by itself alter the status of ‚Äúresident.‚ÄĚ

    For the detailed CMS guidelines see Chapter 12, Section 100, of the Medicare Claims Processing Manual (Pub. 100-4) at the Centers for Medicare & Medicaid Services (CMS) website.
    Eileen Blankenship, CPC
    Remote Coder

  3. #3
    Milwaukee WI
    Default Fellow = resident
    For the specialty in which the fellow is studying, s/he is treated as a resident; i.e. you don't bill for those services under the fellow's name.

    However ... occasionally you may have a fellow who is already board certified in a different specialty and s/he may be billable in that area under the fellow's own NPI. Example: Anesthesia fellow cannot bill for services in anesthesia, but if the fellow also covers the ER on the weekends, you may be able to bill for THOSE services with the fellow's own NPI.

    Also, a fellow CAN request a consult, and you could use the fellow's NPI as the requesting physician on your claim form.

    F Tessa Bartels, CPC, CPC-E/M

  4. #4
    This is what I found out from our medical director. We can bill for what the MD is board certified to perform. Such as Internal Medicine MD's who are board certified in Internal Medicine but doing a Fellowship in Hematology, Nephrology etc.... We are only able to bill for the Internal Medicine services because he/she is board certified to provide those services only. Once the fellow is board certified in Hematology, Nephrology etc... than we can bill for those services also.

    I appreciate your quick responses. I learned alot on this subject.

    Thanks, Connie

  5. #5
    We had this very question as well. After consulting many legal opinions, we came to the conclusion that our fellows could bill, as they were performing services in a non-GME teaching facility. They also are in their fifth year of residency, getting only an extra fellowship after they have completed their surgical residency. The key was that our facility did not receive part A payments for their services. And they were board eligible.
    Kelly G.

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