In our last edition of GME @ Dentons, we covered the ins and outs of reimbursement for fellow moonlighting. In several prior editions, we have discussed the potential harm, from a Medicare graduate medical education (GME) perspective, that can befall a non-teaching hospital that hosts resident rotators. The convergence of these two topics prompted an excellent follow-up question from our readers.

Here is the scenario: A fellow in an Accreditation Council for Graduate Medical Education (ACGME)-approved training program at Hospital A is hired to moonlight at Hospital B, which is not a teaching hospital. By hiring the fellow to moonlight, does Hospital B risk triggering the establishment of its Medicare per-resident amount (PRA) or full-time equivalent (FTE) resident caps?

Dentons' answer? So long as the fellow is a licensed practitioner whose moonlighting activities at Hospital B are not performed as part of that resident's training program, the non-teaching hospital does not risk unintentionally establishing its PRA or FTE caps. Only a resident who is participating in a rotation at the non-teaching hospital, in which the resident is functioning in the capacity of a trainee, could trigger establishment of a hospital’s PRA or FTE caps.

Another situation in which the mere presence of a resident or fellow at a non-teaching hospital would not trigger that hospital's PRA or FTE caps involves so-called "shadowing" opportunities. Although the Centers for Medicare & Medicaid Services (CMS) has never officially defined the term "shadowing," the agency has advised informally that "shadowing" is distinguishable from a "rotation" by its unplanned, unscheduled and unpredictable nature.

Hospitals are well advised to ask these types of questions about residents and fellows who will be spending time at their institutions to avoid unintentional establishment of PRAs and FTE caps.