[Maine-NPs] students and documentation

[Liz Duke]

Carolyn Buppert summarized medicare's rules in the April 2006 Green Sheet. To briefly summarize, there are not any rules about NP/PA training but there are about medical students and residents, which can help us gain insight into how medicare views the teaching situation. It is in the medicare claims processing manual, Chapter 12, section 100. 
In a nutshell, you can only bill for what you see and hear and do. Medicare doesn't pay for services provided by students, and any contribution made by the student that is submitted for billing must be performed in the physical presence of the teaching physician. Students may document services in the medical record, however the documentation that may be referred to by the teaching physician is limited to documentation related to ROS and/or past family/social history. The teaching physician may not refer to a student's documentation of physical exam finding or medical decision making in his or her personal note. If the student documents e/m services, the teaching physician must verify and re-document the HPI as well as perform and re-document physical exam and medical decision making activities of the service. The document also defines "physically present" as "located in the same room (or partitioned or curtained area, if the room is subdivided to accommodate multiple patients) as the patient and/or performs a face-to-face service." Buppert recommends NPs be in the same room with the student when the student is seeing the patient and document, or re-document the HPI, the PE and the medical decision making.
 
Liz Duke 


Date: Thu, 8 Nov 2007 06:20:37 -0800From: tweeks04032 at yahoo.comTo: maine-nps at nurse.netSubject: [Maine-NPs] students and documentation

Hello,
 
I am wondering if anyone can clarify for me what students are allowed to do for official documentation in a patient's chart.  I work in an Emergency department where we use the T-system.  I have been having the PA student I am mentoring fill out charts but was advised that she should only be filling out the ROS section.  Does anyone else have experience with this?
 
Thanks,
 
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