During the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) has authorized new flexibility for medical residents and teaching physicians to rely on telehealth when caring for Medicare beneficiaries. For many types of services, it is no longer necessary for the patient, resident and supervising physician to all be in the same location during the clinical encounter.
In general, a teaching physician may bill Medicare for services furnished by a resident only if the physician is physically present for the “key portion” of the service. During the PHE, however, teaching physicians may supervise most services via real-time audio/video technology in lieu of physical presence. (Note: In-person supervision is still required for certain higher-risk services, as described below.) Telehealth services and supervision may be provided from home, as well as from a healthcare setting.
Under this flexibility, permissible configurations include the following scenarios:
The emergency telehealth flexibilities do not apply to the following services:
For these services, the teaching physician must be physically present for the key portion of the service/procedure or for the entire procedure, as applicable under the normal rules for medical residents.
Under the so-called primary care exception, a resident may provide certain low- and mid-level evaluation and management (E/M) services in primary care centers without in-person supervision during the clinical encounter, subject to certain conditions. Notably, the teaching physician must be “immediately available” to the residents as needed, and must review the services furnished either during or after the encounter.
CMS made three changes to the primary care exception for purposes of the COVID‑19 PHE:
The rules on Indirect Medical Education (IME) and Direct Graduate Medical Education (DGME) do not contemplate medical residents providing telehealth services from home or providing in-person services to patients in their own homes. During the PHE, a hospital may claim a resident for IME and DGME purposes as long as (1) the hospital pays the resident’s salary and fringe benefits for the time the resident spends on these activities, consistent with existing rules; (2) the resident performs patient care duties within the scope of the approved residency program; and (3) the services meet appropriate physician supervision requirements, as described above.