January 19, 2023

Some of our residents have shown an interest in moonlighting at our hospital. Is that something we would be able to offer them?

Yes, absolutely! However, there are some parameters the hospital should be aware of when deciding what type of services residents can provide while moonlighting.

As you are probably aware, CMS requires that the services residents provide to inpatients related to their Graduate Medical Education (“GME”) program be billed as GME payments.  These services cannot be billed as physician services.

This also used to be true for inpatient services provided by residents, not related to their GME.  However, in March 2020, CMS issued a new rule that, among other things, changed the language in 42 C.F.R. § 415.208 that lays out the rules for moonlighting. This new rule established that services provided by residents to inpatients at a resident’s home institution, not related to their GME, were covered as physician services and payable under the physician fee schedule if three criteria were met and documented in the medical record:

(i)         The services must be identifiable physician services and meet the conditions for payment,

(ii)        The resident must be fully licensed to practice in the State, and

(iii)       The services performed must be able to be separately identified from those services that are required as part of the approved GME program.

So, while you can offer residents a range of options for moonlighting, it is important to keep in mind the billing consequences for the types of services the resident is providing.

Also, remember that moonlighting residents would need to be granted clinical privileges to provide services outside of their residency program.  Because moonlighting residents have usually not completed a residency program, they are typically not eligible for clinical privileges as Medical Staff members.  Instead, moonlighting residents are often granted privileges as a category of “Licensed Independent Practitioner.”  Be sure to consult your Medical Staff Bylaws and related documents to see how they treat moonlighting residents.