Payment Matters

August 27, 2010

Is She a “Resident� or a “Billing Physician�? CMS Issues Needed Clarification

By: Thomas W. Coons

For years, a continuing source of confusion for academic medical centers has been whether particular individuals undertaking advanced training and labeled as “fellows” are considered to be “residents,” paid for under the Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) formulae, or physicians whose services are reimbursed only through the Medicare Physician Fee Schedule. CMS has now provided substantial clarification to that issue, as part of the inpatient PPS final rule issued August 16, 2010.