How Hospitals Can Recoup Revenue on Resident-rendered Services

To determine how much revenue is lost, Feinstein and his colleagues retrospectively evaluated a prospective database of procedures performed by residents and fellows from March 1998 through 2007. During that period, 14,497 minor procedures were performed without attending supervision, of which 13,343 had valid current procedural terminology codes. (The most commonly performed procedures were central venous line change, arterial line placement, and central venous catheter placement.)

Total charges for these procedures would have been $10,096,931. "Using the mean percentage of patients that carry private insurance at our institution (68%), $6,876,000 could have been billed. Using our historic collection ratios (33%), $2,269,083 in revenue was lost or $232,726 annually during the study period," the authors wrote.

It is unclear why institutions have not billed private insurers for trainees' work in the past, the authors note. It's not unprecedented. Feinstein points that trainees who moonlight at hospitals outside of their home institution can bill for their services. In other words, a procedure performed by a moonlighting resident is billable but that same procedure, done at her home institution, isn't.

An editorial comment accompanying the article touches on this very issue. "Unsupervised procedures performed by residents on non-CMS funded patients should