Page 19 - Medicare Benefit Policy Manual

B3-2020.7, B3-8201, and B3-15016

Part B covers services that attending physicians (other than interns and residents) render
in the teaching setting to individual patients. These include such services as reviewing
the patient’s history and physical exams, personally examining the patient within a
reasonable time after admission, confirming or revising diagnoses, determining the
course of treatment to be followed, assuring that any supervision needed by interns or
residents is furnished, and making frequent review of the patient’s progress. The medical
record must contain signed or countersigned notes by the physician which show that the
physician personally reviewed the patient’s diagnoses, visited the patient at more critical
times of the illness, and discharged the patient. For other services, such as surgical
procedures, notes in the record by interns, residents, or nurses, which indicate that the
physician was physically present when the service was rendered, are sufficient.

Note that, in order to pay a teaching physician under Part B, the teaching physician must
at least be present during the key portion of a service rendered by a resident or intern.
When a resident does a visit without teaching physician presence, the teaching physician
must repeat the key portions of the visit and have his own documentation in order to get
paid.

30.3 - Interns and Residents
(Rev. 1, 10-01-03)
B3-2020.8, A3-3115

For Medicare purposes, the terms “interns” and “residents” include physicians
participating in approved postgraduate training programs and physicians who are not in
approved programs but who are authorized to practice only in a hospital setting, e.g.,
individuals with temporary or restricted licenses, or unlicensed graduates of foreign
medical schools. Where a senior resident has a staff or faculty appointment or is
designated, for example, a “fellow,” it does not change the resident’s status for the
purposes of Medicare coverage and payment. As a general rule, the A/B MAC (A) pays
for services of interns and residents as provider services.

A. Services Furnished by Interns and Residents Within the Scope of an Approved
Training Program

Medical and surgical services furnished by interns and residents within the scope of their
training program are covered as provider services. Effective with services furnished on
or after July 1, 1987, provider services includes medical and surgical services furnished
in a setting that is not part of the provider, where the hospital has agreed to incur all or
substantially all of the costs of training in the nonprovider facility.

Where the provider does not incur all or substantially all of the training costs and the
services are performed by a licensed physician, the services are payable under Part B by
the A/B MAC (B).