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Agree with Jeff, and Jeff Thanks for clearing that up..
At Lebonheur the hospital  required anyone working as an attending ( resident or fellow who was staffing/moonlighting and not in  a trainee role)  to be credentialed and covered by med mal insurance. A training license was not sufficient.. 

The teaching physician rules apply  when the trainees are being "taught". DOcumentation will be required by an attending when the resident or fellow is in a trainee capacity, whether or not they precept residents. Ultimately the resident is being precepted by an attending and it is their note that matters. The precepting fellows note may help support the level of services but may be superfluous if the resident note and attending notes are adequate to support the level of service. . 
Here in FLorida the Medicaid program does allow us to bill for resident services. SO our residents may "moonlight" and are not licensed or credentialed.  We do a teaching note but don't always see the patient if the acuity is low.. Not sure but heard Alabama and possibly Oklahoma also allow for resident or fellow services to be billed.. 


Marty
Martin Herman, M.D.

Pediatric Emergency Medicine 
Sacred Heart Children's Hospital

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> Date: Mon, 17 Nov 2014 16:35:01 +0000
> From: [log in to unmask]
> Subject: Re: Fellow's documentation
> To: [log in to unmask]
> 
> It doesn't matter if the fellow is on the medical staff or not. If the fellow is working a fellow's shift then they fall under the resident teaching physician rules and the attending physician needs to document the appropriate attestation in order to bill the service. Some state Medicaid programs will allow fellows to bill for their services (not requiring an attending's note) but the majority follow the Medicare TP guidelines.
> 
> 
> 
> If the fellow is on a moonlighting shift as a pediatrician then they may bill independently.
> 
> 
> 
> Jeff
> 
> 
> 
> Jeffrey Linzer Sr., MD, FAAP, FACEP
> Professor of Pediatrics and Emergency Medicine
> Emory University School of Medicine
> Associate Medical Director for Compliance
> EPG/Division of Pediatric Emergency Medicine
> Lead Physician, ICD-10-CM Transition Core Leadership Team
> Children's Healthcare of Atlanta
> 
> 
> 
> 
> -----Original Message-----
> From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Christopher Kelly
> Sent: Monday, November 17, 2014 9:50 AM
> To: [log in to unmask]
> Subject: Fellow's documentation
> 
> 
> 
> Question for the group.  How do you deal with documentation by felllows when they are precepting residents.  Do you have three separate notes?  1 by resident, 1 by fellow, 1 by attending? Do you have an abbreviated format?  How does this affect billing?  We are trying to streamline the process without having three complete and potentially contradicting notes.  Any help would be appreciated.
> 
> 
> 
> Thanks,
> 
> 
> 
> Christopher Kelly MD
> 
> Chief, Division of Pediatric Emergency Medicine
> 
> New York Methodist Hospital
> 
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