Don’t Submit Bills for Student Services – Ever!

Recently, some medical practices have had to reimburse the government for bills that showed that students, rather than physicians or licensed practitioners, had furnished services to Medicare beneficiaries.

Apparently, some practitioners believe that if the supervising physician or midlevel provider had countersigned a student’s note or had stated on the record that the supervisor had also seen the patient, the supervisor can submit a bill for the service under the supervisor’s provider number.

Unfortunately, this belief is wrong.

In the CMS Guidelines for Teaching Physicians, Interns and Residents document, it states that Medicare does not “pay for any services furnished by” students.  Since students are learners and not practitioners, they do not have licenses and “are never considered to be billing providers.”

If a practice violates this billing rule, it risks having the government view the submitted bill as a false claim.  Under the False Claims Act, a violation can subject the practice to penalties ranging from $5,000 to $11,000 per claim, along with the possibility of treble damages per claim.

Of course, students should be allowed to participate in the care of patients so they can learn to become good practitioners.  Thus, it is appropriate for students to see patients and to document the visit for educational purposes.  Further, to avoid compliance problems, it may be prudent to segregate students’ notes in a separate teaching file where supervisors can review them.  Even so, it is important to remember that the supervisor must see the patient, examine the patient and document the services furnished to the patient. When submitting the bill for services furnished, it should only include the work and documentation performed by the licensed professional.

Avoid making the mistake of billing for student services and you won’t run afoul of the substantial penalties of the False Claims Act.

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2 Responses to Don’t Submit Bills for Student Services – Ever!

  1. Kathryn Wickenhauser says:

    Are students in this sense defined as medical students, or does the definition of student here include Interns and Residents?

    • Jackie L. Caynon, III says:

      Students in this case are defined as medical students, nursing students, or physician assistant students. In the case of residents, you can use their data entry as long as the teaching physician is in the same room as the physician and patient and the teaching physician is supervising the resident.

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