Basics of Provider-Based and Teaching Physician Services

Provider-Based Physician Services

Providers may retain physicians on a full-time or part-time basis in, for example, the fields of pathology, psychiatry, anesthesiology, and radiology, and in many instances (especially in teaching hospitals) in other fields of medical specialization as well. Any one of these physicians may be engaged in a variety of activities including teaching, research, administration, supervision of professional or technical personnel, service on hospital committees, and other hospital-wide activities, as well as direct medical services to individual patients. The provider’s arrangement may be with a single physician or with a group of physicians who assume joint responsibility for discharging agreed-upon duties. Provider-based physicians may include those on a salary, or a percentage arrangement, lessors of departments, etc. (whether or not they bill patients directly). The services to the patient are known as the professional component. The services to the provider are known as the provider component. Physician Services Group is the expert in physician employment, practice, urgent care operations, hospitalist integration, and more.

The Professional Component 

The professional component of a provider-based physician’s services pertains to that part of the physician’s activities that is directly related to the medical care of the individual patient. It represents remuneration for the identifiable medical services by the physician that contribute to the diagnosis of the patient’s condition or to his treatment. 

The Provider Component

The portion of the physician’s activities representing services that are not directly related to an identifiable part of the medical care of the individual patient is the provider component. Payment for provider component services can be made only to a provider and is included in the provider’s prospective payment system (PPS) rate. Provider services include teaching, research conducted in conjunction with and as part of patient care (to the extent that such costs are not met by special research funds), administration, general supervision of professional or technical personnel, laboratory quality control activities, committee work, the performance of autopsies, and attending conferences as part of the physician’s provider service activities. 

Teaching Physician Services

Medicare Part B covers services that attending physicians (other than interns and residents) render in the teaching setting to individual patients. These include such services as reviewing the patient’s history and physical exams, personally examining the patient within a reasonable time after admission, confirming or revising diagnoses, determining the course of treatment to be followed, and assuring that any supervision needed by interns or residents is furnished, and making a frequent review of the patient’s progress. The medical record must contain signed or countersigned notes by the physician which show that the physician personally reviewed the patient’s diagnoses, visited the patient at more critical times of the illness, and discharged the patient. For other services, such as surgical procedures, notes in the record by interns, residents, or nurses, which indicate that the physician was physically present when the service was rendered, are sufficient. Note that, in order to pay a teaching physician under Part B, the teaching physician must at least be present during the key portion of a service rendered by a resident or intern. When a resident does a visit without a teaching physician’s presence, the teaching physician must repeat the key portions of the visit and have his own documentation in order to get paid.

Interns and Residents

For Medicare purposes, the terms “interns” and “residents” include physicians participating in approved postgraduate training programs and physicians who are not in approved programs but who are authorized to practice only in a hospital setting, e.g., individuals with temporary or restricted licenses, or unlicensed graduates of foreign medical schools. Where a senior resident has a staff or faculty appointment or is designated, for example, a “fellow,” it does not change the resident’s status for the purposes of Medicare coverage and payment. 

We shared the basics of provider-based and teaching physician services for your reference, For detailed information you can refer to “Medicare Benefit Policy Manual Chapter 15“. Medical Billers and Coders (MBC) is a leading revenue cycle company providing complete medical billing services. If you need any assistance in medical billing and coding for your practice, you can contact us at 888-357-3226