Midwife supervising resident

Hello all

One of our local hospital is a teaching hospital. Sometimes our OBGYNs act as "teaching physicians", they supervise deliveries, dictate attestations, and we bill for their services. Recently, our midwives have assumed this role as they are allowed to supervise residents for low risk labors, see below. My question is this: can an NPP (non-physician provider) bill insurance companies as a "teaching physician." All the guidelines I see are specifically for MDs, and do not mention other types of providers.

Thanks

Beth

What constitutes acceptable on site supervision for a PGY-1 (First year) resident caring for a low risk pregnant woman in labor?

Acceptable supervision for a resident who is providing care for such a patient include: (a) a physician with privileges for providing OB labor & delivery services in the hospital associated with the program, (b) a resident who fulfills written program criteria for the supervision of low risk labor, or (c) a licensed midwife with privileges to provide labor and delivery services in the hospital
(ACGME, 2012)


Beth Aldridge, CPC
Coding Manager

Northern California Medical Associates, Inc
Phone: (707) 573-6145
Fax: (707) 573-6932

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Comments

  • edited June 2017


    Sounds like there may be a disconnect between what's allowed versus what can
    be billed. CMS says a teaching physician is a physician. CMS Medicare
    Claims Processing Manual, chapter 12, section 100.1.1 "Teaching Physician -
    A physician (other than another resident) who involves residents in the care
    of his or her patients."



    There tons of other references in CMS where it says "physician or other
    qualified healthcare provider" when the issue being addressed can be
    performed by a MD or PA or NP. On this topic they clearly specify that is
    has to be a physician supervising the resident.



    TT







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  • Thanks Todd

    Only about 5% of our OB patients are on Medicare; I'll have to figure out if other payors follow their guidelines.

    Beth

    Beth Aldridge, CPC
    Coding Manager

    Northern California Medical Associates, Inc
    Phone: (707) 573-6145
    Fax: (707) 573-6932

    ** CONFIDENTIALITY NOTICE ***
    This e-mail transmission may contain PHI (Protected Health Information). If so, this e-mail is HIGHLY CONFIDENTIAL. It is intended for the exclusive use of the addressee. It is to be used only to aid in providing specific healthcare services to this patient. Any other use is a violation of Federal Law (HIPAA) and will be reported as such. If you have received this e-mail in error, please notify the sender immediately by reply e-mail. Please destroy all electronic and hard copies of the communication, including attachments.
  • It has always been my understanding that a midlevel cannot supervise above their own personal credential. Since the resident is an MD, they would not be able to supervise and bill for work performed by a resident.
    M. Dressler, CPC, CEMC

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