General Precepting Guidelines in Family Medicine Continuity Clinic
Updated December 28, 2016
Preceptor will try and be available 5 minutes prior to the start of the session for pre-clinic questions.
The preceptor should stay until all patients have been seen.
If the preceptor has to leave, she should leave a phone number so that the resident can reach her for any additional questions.
Refer to clinic-specific policies regarding staff presence until all patients have left the building.
Per the Medicare teaching physician guidelines, the preceptor has to be "physically present for the critical or key portion, as determined by the teaching physician." The primary care exception (PCE) excludes E&M visits of low complexity, defined as 99211, 99212, 99213, 99202, 99203, and Medicare preventive visits (Welcome to Medicare and Annual Wellness Visits)
For Medicare billing purposes, the preceptor has to be physically present for all procedures.
Swedish applies the Medicare teaching physician guidelines to Medicare, Medicaid and Tricare patients (all publicly-funded insurers).
PGY-1/1st 6 Months:
Every patient must be discussed with preceptor in real time and seen by the preceptor.
No visits are eligible for the Medicare Primary Care Exception.
PGY-1/2nd 6 Months (usually starts Jan. 1):
Every patient should be precepted in real time prior to the patient leaving the clinic.
Preceptor will see patients as required by Medicare guidelines, if resident requests, or if preceptor feels that face-to-face evaluation is warranted
PGY-2, PGY-3, Geriatric Fellows:
Resident should attempt to identify patients who may be higher-level medical decision making (not eligible for PCE) prior to the start of the session.
Preceptor will see patients as required by Medicare guidelines, if resident requests, or if preceptor feels that face-to-face evaluation is warranted.
Resident and preceptor should discuss key diagnoses and management decisions (i.e. orders, labs, etc.) for every patient before the end of the half-day session.
Resident should expect that the preceptor may ask additional questions for further clarification.