Teaching physician and residents must be provided guardrails Attestation optional, but recommended Medical students must be provided education on documentation guidelines and clinical note expectations 2019 HCCA Compliance Institute 22 3/13/2019 12 CMS "Patients Over Paperwork" 2019 Federal Register Changes • Teaching Physician Rules On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the Medicare Physician Fee Schedule final rule, which will positively affect the NP and PA preceptor documentation burden. For those of you providing clinical teaching rotations for advanced practice registered nurse (APRN) and/or PA students, you may be aware Teaching Physician did and documented to support a service. The Teaching Physician must only perform the key elements of the exam. However, the resident's note must be available to review. For example, if the resident's note supports a 99203 and the Teaching Physician is billing a 99205, then the Teaching Physician's note must include requirements were met. As a result, for E/M visits furnished beginning January 1, 2019, the extent of the teaching physician's participation in services involving residents may be demonstrated by notes in the medical records made by a physician, resident, or nurse. documentation review and verification policy under these manual guidelines The calendar year (CY) 2019 PFS final rule is one of several final rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation. Background on the Physician Fee Schedule 11/2/2019: View: Training Guidelines for Physicians and Advanced Clinical Providers Performing Point-of-Care Ultrasound Examinations: 8/12/2019: View: Training Guidelines for Physicians Who Evaluate and Interpret Diagnostic Thyroid, Parathyroid, and Neck Ultrasound Examinations: 5/20/2019: View Rules are changed for teaching physicians documenting Evaluation and Management (E/M) codes being reported to Medicare July 29, 2019. These changes are part of the Center for Medicare & Medicaid Services' (CMS) revamp of E/M payments. This will affect medical coders and billers, especially those working in clinical documentation improvement. The 2019 Medicare allowance for code 99491 is approximately $83.97, which is higher than the allowance of $42.17 for code 99490. The higher rate for code 99491 reflects the fact that the service 3/13/2019 1 Compliance Challenges for Advanced Practice Providers with Teaching Physician guidelines! Scribes • CMS silent on scribes, other than that scribes guidelines or physician presence • Some credential separately and allow independent billing. 3/13/2019 13 Teaching Physician or Resident was physically present (in the room) when the student examined the patient; or Teaching Physician verified the student documentation with the patient in the physical presence of the student. 2. Verification: Teaching Physician personally verified the student documentation relied upon for the level of service November 7, 2019 . Department of Veterans Affairs Veterans Health Administration Washington, DC 20420 . SUPERVISION OF PHYSICIAN, DENTAL, OPTOMETRY, CHIROPRACTIC, AND PODIATRY RESIDENTS 1. REASON FOR ISSUE: This Veterans Health Administration (VHA) directive provides the procedural requirements to ensure proper supervision of residents in Subject: Medi