July 19, 2024
Attestation Statements – Becoming the Expert
By: Aimee Wilcox, CPMA, CCS-P
Medical students become the proud owners of MDs once they have completed medical school; however, to become fully licensed practicing physicians, they must complete additional training. They are required to participate in a three to seven-year residency and fellowship program within their chosen specialty, pass the required medical board exam, and, of course, apply for and receive a medical license to practice medicine in their chosen state. Physicians who wish to practice medicine in multiple states must obtain a medical license from each state where they practice.
An attending physician supervises resident physicians, also referred to as a teaching physician, and performs their duties within a residency program within an approved teaching facility. Although technically a medical doctor, resident physicians are not licensed or experienced enough to practice without supervision. Although we often associate the term resident with physicians, there are also residency and fellowship programs specific to nurse practitioners (NPs) and physician assistants (PAs), also known as nonphysician providers (NPPs). These programs are not mandatory for NPPs like they are for physicians, and it is important to remember that attending NPPs is not qualified to supervise physician residents and fellows.
What is an Attestation Statement, and Why is it Necessary?
First and foremost, the attending physician is fully responsible for the evaluation and treatment of the patient. The resident may perform any of the key and critical portions of the encounter, but the attending must be present for those portions and attest (or declare) that they were present and participated in the service with the resident.
An attending physician’s attestation statement declares they have performed their duty to the patient and resident and fulfilled the billing requirements. While the rules of an attending may vary ever so slightly between specialties, such as Anesthesia, Psychiatric services, or inpatient admissions, the principles are mostly the same in that the attending physician:
- Must be present during critical or key portions of the patient service performed by the resident
- Participates in the evaluation and decision-making to ensure appropriate care is given
- Interprets diagnostic tests and imaging
- Documents an attestation declaring the requirements of an attending were met
- Ensures all documentation meets the coding guidelines for the CPT service to be billed
- Signs the medical record according to the physician’s signature guidelines
- Reports the appropriate E/M or other CPT/HCPCS codes for the services performed and includes modifier GC to show resident physician participation or modifier GE if they were part of the Primary Care Exception rule.
If an attestation statement only contains the attending physician’s signature, it does not meet the requirements for performance and billing, as it does not identify the attending physician’s participation. An example of a good attestation statement would be:
“I was present for and participated in the critical and key portions of the examination and agree with Dr. Resident’s Name findings and treatment plan.”
Attestations vs Split-or-Shared Encounters
While these two types of services include a physician sharing an encounter with another provider, they are truly different services and should not be mistaken. In the case of a teaching physician and resident service, the attestation statement by the licensed provider to ensure the service was performed appropriately and supervised by a licensed physician. The split or shared service, is performed by two licensed providers, who can each bill services under their individual licenses. Each provider performs their portion of the patient evaluation, documents their findings and time, if the visit was based on time, and the provider who performed the majority of the service bills the claim under their license number.
In summation, for a successful reporting of resident and attending physician services, the following points are necessary for success:
- The service was performed by a resident physician and an attending physician in an authorized teaching facility.
- The attending physician is present for the critical and key portions of the patient evaluation and documents if they agree with the resident’s evaluation findings or, if they differ, document their own findings.
- The attestation statement is added to the patient encounter and signed by the attending, adhering to the signature guidelines.
- A review of the documentation shows it meets the code description for either the E/M level of service or the procedure performed.
- The appropriate modifier (e.g., GC or GE) has been added to the codes to indicate that this was part of a teaching physician’s service.
Do you have a compliance policy for attestation statement use in your organization?
The best compliance path forward is to ensure a straightforward policy covering the most common attestations that could be needed.
If you would like to discuss creating a policy or reviewing your compliance needs, just reach out anytime.
