April 15, 2021

Question:
In the new guidelines, how does Time affect billing for a teaching physician’s E/M service when the resident spends a great deal of time with the patient?

Answer:
Good question! CMS reimburses for the services of the attending physician, not the resident in training. Only the time of teaching physician would “count” in the scenario you describe. The new guidelines say that the time of the physician or other qualified health care provider (QHP) is considered. A QHP is a licensed, credentialed provider of E/M services such as a Physician Assistant, Nurse Practitioner or Clinical Nurse Specialist, not a resident. Therefore, we cannot add, or consider, the amount of time the resident spent with the patient. For more information about the new guidelines effective 1/1/21, click here.

*This response is based on the best information available as of 04/15/21.