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Medicare Teaching Physician Guidelines bring relief  by Julie Acker UMA Director of Compliance On Nov. 22, 2002, the federal government announced the issuance of a new set of Medicare Teaching Physician Guidelines.  These guidelines provide instruction to physicians in academic medical centers regarding documentation requirements for clinical services provided with residents in the teaching setting.  “These new regulations have dramatically cut down the paperwork requirements. They are a welcome change.” said Dawn Clancy, M.D., Internal Medicine Department. The old guidelines, in place since July 1996, required the teaching physician to document specific parts of the Medicare patient visit, such as the history of present illness, the elements of the exam and the assessment and plan, even if these elements were previously documented in their entirety by a resident who either performed the service under the supervision of the teaching physician or with the teaching physician. This meant that in many cases the record would contain two complete notes for the same patient visit, one written by the physician and the other by the resident.  The American Association of Medical Colleges and other medical associations had been lobbying for change since 1996. The new guidelines reduce the documentation requirements for evaluation and management type services such as hospital visits, consultations, and office visits.  The Centers for Medicare and Medicaid (CMS) cautions physicians that the presence and participation requirements have not changed. That is, the teaching physician is required by federal statute to be present for the “ key portions or critical portions” of the visit if he/she intends to submit a bill to Medicare for the service.  The benefit comes when the physician is ready to document the service. The teaching physician may review the resident’s note, and if the note is a complete statement of the care that the patient received from the teaching physician and supports the level of service the physician wants to bill for the service, then the teaching physician need only write a summary comment describing briefly his presence and participation in the service and his agreement with or additions to the resident’s documentation.  CMS even included a list of acceptable and unacceptable summary statements to guide phy-sicians in the use of the new regulation.  Departments that use electronic medical records systems such as Practice Partner will find the new regulations especially easy to comply with since the templates help remind the residents to document all the elements of their encounter with the patient.  CMS regulators advised teaching physicians to be sure they specifically state which resident’s note (name of resident and date of note) they are referring to in their statement of agreement with the resident’s documented findings. CMS did not make any changes to the Medicare Teaching Physician Regu-lations for other services. The 1996 guidelines remain in effect for surgical procedures, anesthesia, endoscopy, diagnostic radiology and other diagnostic tests, psychiatry, time based codes, complex or high risk procedures, renal dialysis, obstetrics and the Primary Care Exception. For more information, go to the UMA Compliance Web site at http://www.musc.edu/uma/compliance/TPregs.html. There you will find the complete regulations for Medicare and Medicaid as well as a one page “Tip Sheet” http://www.musc.edu/uma/compliance/tips/tip0103.html to help you understand the new requirements. You can also contact the UMA Compliance Department at 876-1321 for more information.   Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.