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2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 8. Physician : 8.2 Services, Benefits, Limitations, and Prior Authorization : 8.2.1 Teaching Physician and Resident Physician

Teaching Physician and Resident Physician
The roles of the teaching physician and resident physician occur in the context of an accredited graduate medical education (GME) training program.
The teaching physician is the Medicaid‑enrolled physician who is professionally responsible for the particular services that were provided and are being submitted for reimbursement; the physician must be affiliated and in good standing with an accredited GME program and must possess all appropriate licensure.
Physician services must be performed personally by the teaching physician or by the person to whom the physician has delegated the responsibility. The level of supervision required may be direct or personal.
In all cases, the client’s medical record must clearly document that the teaching physician provided identifiable supervision of the resident. As defined below, the supervision must be direct or personal depending on the setting and the clinical circumstances:
Direct supervision means that the teaching physician must be in the building of the office or facility when and where the service is provided.
Personal supervision means that the teaching physician must be physically present in the room when and where the service is being provided.
The teaching physician must provide personal supervision during all medically complex situations, dangerous procedures, or major surgery. A service or procedure is complex or dangerous if deviation from the expected technique at the time the procedure or service is performed presents a medically reasonable and immediate risk to the patient’s life or health. This criterion applies regardless of the place of service.
The teaching physician must provide medically appropriate, identifiable direct supervision for all other services that do not require personal supervision.
The following prerequisites apply when the teaching physician submits claims for services performed, in whole or in part, by the resident physician in the inpatient hospital setting, the outpatient hospital setting, and surgical services and procedures.

Texas Medicaid & Healthcare Partnership
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