I work with residents and medical students (all types) on a regular basis, and have researched this area extensively.

Firstly, CMS defines a student as such:

“Student – An individual who participates in an accredited educational program (e.g., a

medical school) that is not an approved GME program. A student is never considered to

be an intern or a resident. Medicare does not pay for any service furnished by a student.

See 100.1.1B for a discussion concerning E/M service documentation performed by

students.”

An accredited educational program would include persons who are PA and ARNP students.

CMS further explains through MLN:

“E/M Documentation Provided by Students
Any contribution and participation of a student to the performance of a billable service (other than review

of systems and/or past family/social history which are not separately billable, but are taken as part of

an E/M service) must be performed in the physical presence of a teaching physician or the physical

presence of a resident in a service that meets the requirements in this section for teaching physician

billing. Students may document services in the medical record; however, the teaching physician must

verify in the medical record all student documentation or findings, including history, physical exam,

and/or medical decision making. The teaching physician must personally perform (or re-perform) the

physical exam and medical decision making activities of the E/M service being billed and may verify

any student documentation of them in the medical record rather than re-documenting this work.”

This means that the student CAN perform E/M elements as long as the teaching physician is right there with them, and that the teaching physician MUST review and verify any documentation done by the student. Curiously enough, CMS does say that the teaching physician have to perform the Exam and the MDM, which to me indicates that the student should not perform those components. Note that CMS adds that if the student does the Exam and/or MDM, then the teaching physician should re-perform the exam and/or MDM done by the student.

As you mentioned, there was a change of documentation rule recently (earlier this year) which removed the need for the teaching physician to re-document anything done by the student outside the ROS and/or PFSH.

Hope that helps.