Services of Interns And Residents

90 - Services of Interns And Residents (Rev. 1, 10-01-03) A3-3115, HO-237 A. General 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 reimbursement. As a general rule, services of interns and residents are paid as provider services by the A/B MAC (A). B. 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, this includes services furnished in a setting which is not part of the provider where a hospital has agreed to incur all or substantially all of the costs of training in the nonprovider facility. Providers are required to notify the A/B MAC (B) of such agreements. 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 reimbursable on a reasonable charge basis by the A/B MAC (B). Prior to July 1, 1987, the covered services of interns and residents were reimbursed by the A/B MAC (B) on a reasonable charge basis as physician services if furnished by a licensed physician off the provider premises regardless of who incurred the training costs. C. Services Furnished by Interns and Residents Outside the Scope of an Approved Training Program - Moonlighting Medical and surgical services furnished by interns and residents that are not related to their training program, and are performed outside the facility where they have their training program, are covered as physicians’ services and paid on a reasonable charge basis where the requirements in 1 and 2, below, are met. Medical and surgical services furnished by interns and residents that are not related to their training program, and are performed in an outpatient department or emergency room of the hospital where they have their training program, are covered as physicians’ services and paid on a reasonable charge basis where the following criteria are met: 1. The services are identifiable physicians’ services, the nature of which requires performance by a physician in person and which contributes to the diagnosis or treatment of the patient’s condition; 2. The intern or resident is fully licensed to practice medicine, osteopathy, dentistry or podiatry by the State in which the services are performed; and 3. The services performed can be separately identified from those services that are required as part of the training program. When these criteria are met, the services are considered to have been furnished by the individuals in their capacity as physicians and not in their capacity as interns and residents.