Section 6.B: Moonlighting Policy

GMEC approved 1/21/2026

Scope:
Applies to all Emory University School of Medicine (“EUSOM”) Residents and fellows (“Residents”) in Accreditation Council for Graduate Medical Education (“ACGME”) accredited and in non-ACGME accredited/non-standard programs appointed through the House Officer Contract issued by the EUSOM Graduate Medical Education Office (“GME Office”). 

Definitions:

• "Moonlighting" refers to a service performed by a Resident, outside the scope of their residency training program.
• "External moonlighting" refers to moonlighting at a non–EUSOM affiliated facility.
• "Internal moonlighting" refers to moonlighting within an EUSOM affiliated facility (including Emory Healthcare, Grady Memorial Hospital, Children’s Hospital of Atlanta and the Atlanta Veterans Administration Medical Center).

Eligibility:

• Current PGY-2 or higher Residents in good standing and meeting expected academic and clinical performance progress standards as defined by their program.
• EUSOM supports equal moonlighting opportunities for all Residents and fellows, including those holding visas. Moonlighting activities for visa-holding Residents must be compatible with the Resident’s visa status and in compliance with requirements set forth by the US Department of State. See below for process to request internal moonlighting privileges for visa-holding Residents (6.B.03 & 6.B.04). 
• U.S. active-duty military Residents are prohibited from moonlighting when so stipulated by their US Department of Defense contract.

Conditions:

• Residents are never required to engage in moonlighting.
• Residents are prohibited from external or internal moonlighting without the prior written approval of the Program Director or their The requirements necessary for such approval are set forth below under "External Moonlighting" and "Internal Moonlighting”.
• All moonlighting hours (external and internal) must be counted toward the ACGME mandated 80-hour duty hour limit.
• Residents must have malpractice insurance coverage (see internal and external moonlighting requirements for specifics).
• Residents may not be “on-call” or be assigned “Jeopardy” while moonlighting. Residents may not moonlight while on leave. 
• Moonlighting may not interfere with a Resident’s dedicated participation in their training program or their ability to provide quality care to patients.
• The Program Director and/or their designee have the right to deny or suspend moonlighting privileges at any time if the Program Director determines there is interference with Resident’s primary clinical and/or educational responsibilities within the training program, the Resident is not in good standing or not meeting academic or clinical expectations, or based on other individual circumstances as determined by the Program Director.
• J-1/H-1B visas holders are not allowed to perform external moonlighting based on visa requirements.

6.B.01: External Moonlighting Requirements: 

1. The Resident must follow the general conditions for moonlighting outlined above including counting all hours toward the ACGME 80-hour-work-hour limit.
2. The Resident must complete the “Request to do External Moonlighting” form and obtain their Program Director’s signature on the completed form which will be kept on file in the program’s records. Approval is valid for up to 6 months.  After that period, the Resident must submit a new form and obtain a new signature to continue moonlighting.  [Link to request external moonlighting here].
3. To be considered for external moonlighting, the Resident must meet the following requirements:
   • Residents must obtain a signed contract with the external facility and provide a copy of the signed contract to the Program Director to review, including proof that the Resident has clinical privileges at the moonlighting site.
   • Residents must provide the Program Director with proof of professional liability coverage in place prior to the start of moonlighting and either:
     1. The contract must state that the moonlighting employer will provide professional liability insurance coverage for the Resident's moonlighting services, OR,
     2. If the external facility does not provide insurance coverage, Residents must obtain their own professional liability insurance, for no less than limits of $1 million per claim and $3 million in the annual aggregate and provide documentation of the coverage to their Program Director.
   • Residents must be fully licensed to practice medicine in the State where the moonlighting will occur. (External moonlighting is not permissible with a training permit).
   • Residents on J-1/H-1B may not engage in external moonlighting based on visa requirements.
   • Residents must not wear EUSOM badges or identifiers when moonlighting externally.

6.B.02: Internal Moonlighting Requirements:

1. The Resident must follow the general conditions for moonlighting outlined above including counting all hours toward the ACGME 80-hour-work-hour limit.
2. The Resident must complete the “Request to do Internal Moonlighting” form for approval to moonlight within EUSOM affiliated facility (including Emory Healthcare, Grady Memorial Hospital, Children’s Hospital of Atlanta and the Atlanta Veterans Administration Medical Center). Residents must obtain their Program Director’s signature on the completed form which will be kept on file in the program’s records. Approval is valid for up to 6 months.  After that period, the Resident must submit a new form and obtain a new signature to continue moonlighting by completing the "Request to do Internal Moonlighting" form. [Link to form to request internal moonlighting]
3. To be considered for internal moonlighting, the Resident must meet the following requirements:
   • Residents must conform with Federal Center for Medicare and Medicaid Services (CMS) regulations as described in Policy 6.C: Resident Professional Fee Billing Policy when moonlighting in any EUSOM affiliated hospital.
   • For Internal Moonlighting, Emory’s Liability Insurance Program provides malpractice insurance for Residents who moonlight within Emory-affiliated facilities.
   • Residents must follow licensure requirements including:
     1. If a Resident is moonlighting as an independent provider and independent of their training program, they must hold a full, unrestricted Georgia medical license.
     2. If the moonlighting activity involves working extra shifts in the role of a Resident, under the standard supervision of EUSOM faculty expected in their training program, the Resident my do so with a valid Georgia training permit.
   • Residents on J-1/H-1B visas must follow the additional requirements below as required by the US State Department (see below). 

6.B.03: Intealth J-1 Visa-Holder Internal Moonlighting Requirements and Request Process:

1. Intealth J-1 visa holders must comply with all Emory GME moonlighting conditions and requirements listed above including obtaining signed Program Director approval [link here] and counting hours toward ACGME duty hour limits.
2. Intealth J-1 Visa Holder Moonlighting Restrictions:
   • Activities must take place within the same institution or primary clinical site as the physician’s accredited or non-standard training program.
   • Only Internal Moonlighting is allowed; External Moonlighting, direct billing, independent billing or billing as an attending are prohibited.
   • Must obtain approval from Intealth prior to start of moonlighting (see process below).
   • Must comply with Emory GME institutional policies regarding moonlighting and ACGME duty hour limitations
   • Must not interfere with core training responsibilities and educational objectives
   • Resident must be in good standing
   • Moonlighting activities must not extend the total training duration
   • A new/updated DS-2019 (and new I9) may be required for extra income above $3000 listed on the form (per Intealth) 
   • Violation of any of these restrictions would constitute a violation of visa terms and could result in visa revocation or termination 
3. Intealth J-1 Visa Holder Moonlighting Request Process
   • Step 1: The program director must complete the Intealth form
   • Step 2: The program director or coordinator uploads and submits the form to Emory GME for review via the GME moonlighting application
   • Step 3: GME Deans review/approve the request
   • Step 4: Emory GME staff member (the training program liaison) uploads the form to Intealth for approval
   • Step 5: Resident is notified by Intealth when and if Resident is approved for internal moonlighting. Moonlighting must not start until Intealth approval is confirmed.

6.B.04: H-1B Visa-Holder Internal Moonlighting Requirements and Request Process:  

1. H-1B visa holders must comply with all Emory GME moonlighting conditions and requirements as listed above including obtaining signed Program Director approval and counting hours toward ACGME duty hour limits.
2. H-1B Visa Holder Moonlighting Restrictions:
   • Activities must take place within the same institution or primary clinical site as the physician’s accredited or non-standard training program.
   • Only Internal Moonlighting is allowed; External Moonlighting, direct billing, independent billing or billing as an attending are prohibited.
   • Must obtain Emory GME approval prior to start of moonlighting (see process below).
   • Must comply with Emory GME institutional policies regarding moonlighting and ACGME duty hour limitations
   • Must not interfere with core training responsibilities and educational objectives
   • Resident must be in good standing
   • Moonlighting activities must not extend the total training duration
   • Violation of any of these restrictions would constitute a violation of visa terms and could result in visa revocation or termination
3. H-1B Visa Holder Moonlighting Request Process
   • Step 1: The Resident completes the GME H-1B visa holder request for moonlighting (linked here).
   • Step 2: GME Deans and ISSS review/approve the request
   • Step 3: Emory GME staff member notifies the Resident and Program Director if/when approval is granted. Moonlighting must not start until approval is confirmed.

6.C. Resident Professional Fee Billing Policy

• Federal regulations and CMS have established rules governing the payment for services performed by Residents who are in an approved training program based on the setting where the services are performed (42 CFR 415.208, linked here).  Medicare regulations include “Fellow” in its definition of a Resident.  Approved training programs include those Resident training programs approved by the Accreditation Council for Graduate Medical Education (ACGME) or member Boards of the American Board of Medical Specialties (ABMS).
• Emory University School of Medicine (EUSOM) GME will follow the Medicare billing rules and additional Emory-specific requirements for all payers unless an exception is granted for a specific Resident in circumstances where their training is not funded by CMS.
• In most cases, a Resident may not bill for professional services when working in an Emory-affiliated facility.  Whether a Resident may bill for professional or patient care activities and what conditions apply to that billing activity depend on the location where the activities are performed and the Resident’s funding source. The Resident must also have the appropriate hospital and managed care plan credentialing necessary for billing.
• For Residents funded through traditional Federal CMS Direct Medical Education (DME)/Indirect Medical Education (IME) hospital payments at EUSOM-affiliated institutions the Resident may bill for patient care services in any setting, including inpatient units of their training hospital, if the following are true:
  1. The activity is not in the same subspecialty as the Resident’s Emory training program and is outside the scope of the Resident’s training program.
  2. The Resident is fully licensed to practice medicine in the state where services are performed.
  3. The services are identifiable physician services, not part of training, and meet all billing requirements under §415.102(a).
  4. The services are clearly documented in the medical record as separate from GME duties.
  5. The Resident complies with all other elements of the EUSOM Moonlighting policy.
• Residents funded through non-traditional (non-CMS) sources at EUSOM-affiliated institutions may moonlight and bill for patient services under the same policies.