|Title: Billing for Teaching Physicians|
|Issued:||12/01/1997||Reviewed/Revision Date:||08/21/2000, 10/06/2009, 05/05/2011, 01/16/2012, 12/09/2014|
Physician services are provided to patients by faculty members of USC Care Medical Group, as well as by physicians enrolled in accredited internship, residency, and fellowship programs with the USC system, and appropriate non-physician providers. Only those professional services provided by billable providers or resident physicians adequately supervised by faculty physicians, and documented in the medical record, are billable to third party payers and/or patients. USC is committed to full compliance with the laws and regulations that apply to our institution, including all federal health care programs (such as Medicare and Medi-Cal) requirements, and is committed to prepare and submit accurate claims consistent with such requirements.
USC has adopted the principles of billing for teaching physician services as established by the Medicare program, except when specific payers require a higher standard. For example, a payer may require personal involvement of the teaching physician for all services (as opposed to the primary care exception) in order to bill for professional component services.
USC Healthcare Compliance Program will promote billing practices that:
Educate providers in the accurate billing and documentation required in the varied medical or surgical incidences;
Provide a centralized area for support and interaction when questions arise and;
Promote documentation by physicians to reflect accurate involvement by the teaching physician in the key portions of services/procedures;
Examples of appropriate teaching physician statement documentation:
Teaching Physician and Resident at different times: I saw and examined the patient and agree with the resident’s findings and plan as written (see residents note for details).
Teaching Physician and Resident together: I was present with the resident during the history and exam. I discussed the case with the resident and agree with the findings and plan as documented in the resident’s note. Except/Additionally: ______________________.
Evaluation and Management with Procedure which is less than 5 minutes. I saw and examined the patient and discussed with the resident, agree with the resident’s note and I was present for the entire procedure.
Evaluation and Management with Procedure which is greater than 5 minutes. I saw and examined the patient and discussed with the resident, agree with the resident’s note and I was present for the key and critical portions of the procedure/surgery and I was immediately available to provide assistance.
Evaluation and Management with EKG. I saw and examined the patient and discussed with the resident, agree with the resident’s note and I have read the EKG. I have reviewed and/or edited the resident’s interpretation and I agree.
Procedure which is less than 5 minutes. I was present for the entire procedure.
Surgery/Procedure. I was present for the key and critical portions of the procedure/surgery and I was immediately available to provide assistance.
Diagnostic Tests. I personally reviewed the film(s) and/or test(s) and agree with the resident’s interpretation.
EKG. I have read the EKG and agree with the resident’s interpretation.
Endoscopy Procedures. I was present for the entire procedure from the insertion of the scope until it was withdrawn.
Delivery. I was present for the Delivery.
Other TP Statement: ________________________________________________.
Questions regarding policies, procedures or interpretations should be directed to the USC Office of Culture, Ethics and Compliance at (323) 442-8588 or USC Help & Reporting Line at (213) 740-2500 or (800) 348-7454.