ABSTRACT
The key principle in supervising resident care is that the teaching physician must ensure that the medical care provided is appropriate. In an attempt to ensure this overseeing of a resident physician's care, the CMS requires that the teaching physician either personally performs the service or is 'physically present during the critical or key portions of the service that a resident performs.' The 'critical or key portion' of a service is determined by the teaching physician, and will vary depending on the patient and the required medical care. For example, a patient presenting with an exacerbation of asthma might have the assessment of their respiratory status and determination of a treatment plan identified as the critical portion of their care. Another patient presenting with the same condition might require, as the key portion of their care, appropriate counseling on the use of their medications. It is the teaching physician's responsibility to define and be present for these 'critical or key' components. A caveat to this guideline occurs during visits that are billed on the basis of time. By billing by time you have defined the key component of this visit as the time spent with the patient. You
that specified amount of time.
