Residents providing the billable patient care service without the physical presence of a teaching physician must have completed at least sixmonths of a GME approved residency program. }); Including updates on CPT and CMS coding changes for 2023, Last revised January 12, 2023 - Betsy Nicoletti Tags: teaching physician rules. Share sensitive information only on official, secure websites. Receiving a staff or faculty appointment or participating in a fellowship does not by itself alter the status of 'resident.' What guidance would you give a medical student when helping to document a patient encounter for a teaching physician? GUIDELINES FOR TEACHING PHYSICIANS, INTERNS, AND RESIDENTS | Guidance CMS will not be liable for any claims attributable to any errors, omissions, or other inaccuracies in the information or material covered by this license. Teaching Physician Attestations - Procedures - Medical School By clicking below on the button labeled I accept, you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. // Going backwards: from bytestream, to percent-encoding, to original string. For services in this category, do not add time spent by the resident in the absence of the teaching physician. The focus of this article is to narrow down on what the attendings are required to say (demonstrate) in . As before, any contribution and participation of a medical student to a billable service (other than the review of systems and/or past family/social history) must be performed in the physical presence of a resident or teaching physician. We are attempting to open this content in a new window. Medicaid - Guidance Documents - New York State Department of Health This audit tool for modifier 25 will help determine if a separate E/M service should be reported. Informed Consent | ACS - The American College of Surgeons Home Health Nursing and Therapy Visits. All patients seen by a medical student must be seen and have their care supervised by a physician. CMS Releases Final 2022 Medicare Physician Fee Schedule Either the resident or the teaching physician must provide customized information that is sufficient to support a medical necessity determination. if (!encodedData) { We also noted that, while the proposed change addresses who may document services in the medical record, subject to review and verification by the furnishing and billing clinician, it would not modify the scope of, or standards for, the documentation that is needed in the medical record to demonstrate medical necessity of services, or otherwise for purposes of appropriate medical recordkeeping.. Also, the teaching physician must personally perform (or reperform) the physical exam and medical decision making activities of the E/M service being billed, but verification of student documentation in the medical record is allowed, rather than redocumenting this work. Copyright American Medical Association. If a resident prepares and signs the interpretation, the teaching physician must indicate that he/she has personally reviewed the image and the resident's interpretation and either agrees with it or edits the findings. CodingIntel was founded by consultant and coding expert Betsy Nicoletti. or The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Parenting is one of the most complex and challenging jobs you'll face in your lifetime -- but also the most rewarding. PDF Assistant-at-Surgery Services Policy, Professional - UHCprovider.com Jurisdiction M Home Health and Hospice MAC, {"DID":"crit32a323","Sites":"JJA^JJB^JMA^JMB^JMHHH","Start Date":"06-14-2023 15:04","End Date":"06-16-2023 17:30","Content":"The Palmetto GBA Jurisdictions J and M Provider Contact Center (PCC) will be closed for an eight-hour staff training on Friday, June 16, 2023. Has CMS provided examples of acceptable and unacceptable teaching physician documentation? Certain fellows may not meet the definition of a 'resident' in Transmittal 1780 and may be eligible to perform, document, and bill for services without additional oversight. The presence and participation of the teaching physician in the management of the patient must be documented. The primary care setting is the one area the teaching physician gets a pass on the personal presence requirement when using residents in the care of their patients. The calendar year (CY) 2024 PFS proposed rule is one of several proposed rules that reflect a . Each facility will determine for themselves the timing and extent of the H&P required for outpatient procedures. tmpArr[ac++] = String.fromCharCode(o1) When involving residents in the care of patients, teaching attendings must demonstrate that the appropriate level of supervision was provided for each type of procedure or service performed. ","URL":"","Target":null,"Color":"blue","Mode":"Standard\n","Priority":"yes"}, {"DID":"critd1a1c4","Sites":"JJA^JJB^JMA^JMB^JMHHH","Start Date":"06-29-2023 09:58","End Date":"07-04-2023 17:30","Content":"The Palmetto GBA Provider Contact Center (PCC) will be closed Tuesday, July 4, 2023, in observance of Independence Day. var o3 The Teaching Physician Guidelines apply to the care provided by interns, residents, and fellows ("residents"). The new rules allow the attending, the resident or the nurse to document the attending's participation in the care of the patient when performing an E/M service. GC - JE Part B - Noridian - Noridian Medicare By a resident seeing a patient in the "physical presence" of a teaching physician who documents his or her presence during the performance of the critical or key portions of the service and discussion of the case with the resident. ACEP offers the following sample attestation when supervising a resident for your consideration: I, Dr. X, personally saw the patient, performed critical or key portions of the service, and discussed the care with the resident. From choosing baby's name to helping a teenager choose a college, you'll make . When using an electronic medical record, it is acceptable for the teaching physician to use a macro for documentation if the teaching physician adds it personally in a secured (password protected) system. Toll Free Call Center: 1-877-696-6775. In transmittal 4283, CMS also eliminated all of the previous examples of acceptable and unacceptable documentation. Physically Present The teaching physician is located in the same room (or partitioned or curtained area, if the room is subdivided to accommodate multiple patients) as the patient and/or performs a face-to-face service. Critical care is the direct delivery by a physician (s) or other QHP of medical care for a critically ill/injured patient in which there is acute impairment of one or more vital organ systems, such that there is a probability of imminent or life-threatening deterioration of the patient's condition. return decodeUTF8string(dec.replace(/\0+$/, '')) Texas Medicaid Provider Procedures Manual | TMHP This guide describes the coding rules related to lesion destruction, laceration repair, wound care, removal of foreign body and other common in-office procedures. This product educates health care providers about payment requirements for physician services in teaching settings, general documentation guidelines, evaluation and management (E/M) documentation guidelines, and exceptions for E/M services furnished in certain primary care centers. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. Applicable FARS/DFARS Clauses Apply. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt . h1 = b64.indexOf(encodedData.charAt(i++)) CMS MLN BOOKLET FEDERALLY QUALIFIED HEALTH CENTER GUIDELINES FOR TEACHING PHYSICIANS, INTERNS, AND RESIDENTS FOR MEDICARE FEE-FOR-SERVICE PROVIDERS means youve safely connected to the .gov website. The Centers for Medicare and Medicaid Services (CMS) has detailed specific documentation requirements for Teaching Physician (TP) Attestations for surgical procedures, procedures, and fracture care management when supervising residents. The above attestation would cover E/M services in addition to any procedures or diagnostic tests. All Rights Reserved. Any resource shared within the permissions granted here may not be altered in any way, and should retain all copyright information and logos. What service must be provided and documented in order for the teaching physician to bill Medicare for surgical procedures? E/M visit billing information for teaching physicians has been updated. The responsibility for the content of this file/product is with Palmetto GBA or CMS and no endorsement by the AMA is intended or implied. She knows what questions need answers and developed this resource to answer those questions. Download the Guidance Document Final lock Comprehensive Health and Physical Education - The Official Web Site for X0043. var o2 Changes in 2023: Evaluation and Management Guidelines . h3 = b64.indexOf(encodedData.charAt(i++)) Teaching Physician Rules | Quick Reference Guide - CodingIntel Each procedure requires specific documentation for accurate coding. return decodeUTF8string(window.atob(encodedData)) ","URL":"","Target":null,"Color":"blue","Mode":"Standard\n","Priority":"yes"}, {"DID":"crit34c5e3","Sites":"JJA^JJB^JMA^JMB^JMHHH^Railroad Medicare","Start Date":"03-24-2023 08:40","End Date":"03-26-2023 12:00","Content":"eServices eAudit data is currently unavailable. When to Refill? How does the 2019 CMS Physician Final Ruleapply to Nurse Practitioner (NP) and Physician Assistant (PA) Students? If you do not agree to the terms and conditions, you may not access or use software. The American Medical Association has released the new guidelines for Evaluation and Management (E/M) services which will go into effect on January 1, 2023. PDF Teaching Physician Guidelines for Surgical Procedures Acute Care Surgery Billing, Coding and Documentation Series Part 2 We are attempting to open this content in a new window. var h4 We'll continue to pay a total payment of approximately $76 per dose to administer COVID-19 vaccines in the home for certain Medicare patients through calendar year 2023. While physicians have been subjected to across-the-board cuts for the last several years . The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Guidance for this chapter provides claims processing instructions for physician and nonphysician practitioner services. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The Medicare Claims Processing Manual, Chapter 12 contains the Calendar year 2022 changes to Medicare Part B Payment Policies Final Rule (CMS-1751-F). Required on an intermittent basis. The term includes interns and fellows in GME programs recognized as approved for purposes of direct GME payments made by the fiscal intermediary. } In addition, as of 1-1-2020 teaching physicians and Advanced Practice Providers (APPs) can now review and verify Physician Assistant (PA) and Nurse Practitioner (NP) student documentation as well. These services may not be billed or paid under the Medicare PFS. An official website of the United States government incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted Instead you must click below on the button labeled I DO NOT ACCEPT and exit from this computer screen. These modifiers are reported in the modifier column of the CMS1500 form next to the service to which they are being applied. Description. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. See FAQs12-16for additional student performance and documentation guidance. 100.1 - Payment for Physician Services in Teaching Settings Under the MPFS 100.1.1 - Evaluation and Management (E/M) Services 100.1.2 - Surgical Procedures 100.1.3 - Psychiatry 100.1.4 - Time-Based Codes 100.1.5 - Other Complex or High-Risk Procedures 100.1.6 - Miscellaneous 100.1.7 - Assistants at Surgery in Teaching Hospitals For additional resources, see The CodingIntel guide to Teaching Physician Rules, Teaching physician articles and tips, and Copyright 2023, CodingIntel . The process culminates in the patient's decision to a specific treatment or procedure. License to use CDT for any use not authorized herein must be obtainedthrough the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611.Applications are available at the American Dental Association web site. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)(June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements. Personally by a teaching physician who is not a resident. Under the rule, the conversion factor will decrease by $1.30 on Jan. 1, 2022, going from $34.89 to $33.59. PDF Teaching Physician Guidelines for Medicare, Medicaid and TRICARE Working for a level one trauma center, with attendings, physician assistants, nurse practitioners, residents, and students, can be especially . Similar articles that you may find useful: CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). Any use not authorized herein is prohibited, including by way of illustration and not by way oflimitation, making copies of CDT for resale and/or license, transferring copies of CDT to any partynot bound by this agreement, creating any modified or derivative work of CDT, or making anycommercial use of CDT. Pursuant to 42 CFR 415.172 (b), documentation must identify, at a minimum, the service furnished, the participation of the teaching physician in providing the service, and whether the teaching physician was physically present. Critical Care Services - JE Part B - Noridian - Noridian Medicare ET on Friday, March 10, 2023, for staff training. In no event shall ACEP be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Medical coding resources for physicians and their staff. Time spent by the resident, in the absence of the teaching physician, cannot be billed by the teaching physician as critical care or other time-based services. Specific coding or payment related issues should be directed to the payer.For information about this FAQ/Pearl, or to provide feedback, please contact David A. McKenzie, ACEP Reimbursement Director at (469) 499-0133 ordmckenzie@acep.org. Official websites use .govA Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. These modifiers must be added if the service of a resident is being counted for credit towards the documentation requirements of a teaching physician. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: November 01, 2019 Fields with a red asterisk (. For more information on the requirements and restrictions of the Primary Care Exemption, refer to 42 CFR 413.78(e)(3)(ii), 42 CFR 413.79(a)(6) and Publication 100-04 Medicare Claims Processing Manual, Chapter 12, Section 100.1.1. The teaching physician must personally perform (or re-perform) the physical exam and medical decision-making activities of the E/M service being billed, but may verify any student documentation of them in the medical record, rather than re-documenting this work. For procedure codes determined on the basis of time, the teaching physician must be present for the period of time for which the claim is made. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. o3 = bits & 0xff By Tammy R. Seel, CPC, CPMA, CEMC, CEDC, AAPC Fellow. } else { Enteral Products List Guideline Fee Schedule Changes for Prosthetics Fee Schedule Changes for Durable Medical Equipment Guidelines for Delivery of Prescription Drugs, OTC Products, M/S Supplies and DME November 2003 Important Pharmacy & DME Contact Numbers Medical-Surgical Supplies. 200 Independence Avenue, S.W. However, effective January 1, 2022, teaching physicians must use medical decision making (MDM) for purposes of E/M visit level selection when billing the Medicare program under the physician fee schedule for office/outpatient E/M visits under this primary care exception. Teaching physician rules | Bedside procedures - CodingIntel If the teaching physician's signature is the only signature on the interpretation, Medicare assumes that he/she is indicating that he/she personally performed the interpretation. Included below are references for several transmittal updates. dec = tmpArr.join('') ","URL":"","Target":null,"Color":"blue","Mode":"Standard\n","Priority":"no"}, {"DID":"crita54bdb","Sites":"JJA^JJB^JMA^JMB^JMHHH","Start Date":"05-24-2023 13:47","End Date":"05-29-2023 18:00","Content":"The Palmetto GBA Provider Contact Center (PCC) will be closed Monday, May 29, 2023, in observance of Memorial Day. ) The teaching physician may refer to the residents documentation for specific patient history, physical findings and medical assessment. var h2 var h1 Coding Guide - Minor Surgical Procedures - CodingIntel on the guidance repository, except to establish historical facts. Significant changes have been made to documentation required of teaching physicians for services performed by resident physicians, medical student contributions to documentation, and the definition of the critical or key portions of an E/M service. (The usual circumstance in an ED with residents working under the guidance and supervision of teaching physicians). that the patient was critically ill during the time the teaching physician saw the patient, what made the patient critically ill; and. The American College of Emergency Physicians (ACEP) has developed the Reimbursement & Coding FAQs and Pearls for informational purposes only. The sole responsibility for software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. ACEP, its committee members, authors or editors assume no responsibility for, and expressly disclaim liability for, damages of any kind arising out of or relating to any use, non-use, interpretation of, or reliance on information contained or not contained in the FAQs and Pearls. Medicare pays for Resident Physician services through Part A to the hospital. The teaching physician rules describe a payment method by which Medicare pays an attending physician or teaching physician for services performed jointly with an intern, resident, or fellow, in an approved graduate medical education program (GME). .fl-builder-content *,.fl-builder-content *:before,.fl-builder-content *:after {-webkit-box-sizing: border-box;-moz-box-sizing: border-box;box-sizing: border-box;}.fl-row:before,.fl-row:after,.fl-row-content:before,.fl-row-content:after,.fl-col-group:before,.fl-col-group:after,.fl-col:before,.fl-col:after,.fl-module:before,.fl-module:after,.fl-module-content:before,.fl-module-content:after {display: table;content: " ";}.fl-row:after,.fl-row-content:after,.fl-col-group:after,.fl-col:after,.fl-module:after,.fl-module-content:after {clear: both;}.fl-clear {clear: both;}.fl-clearfix:before,.fl-clearfix:after {display: table;content: " ";}.fl-clearfix:after {clear: both;}.sr-only {position: absolute;width: 1px;height: 1px;padding: 0;overflow: hidden;clip: rect(0,0,0,0);white-space: nowrap;border: 0;}.fl-visible-large,.fl-visible-medium,.fl-visible-mobile,.fl-col-group-equal-height .fl-col.fl-visible-large,.fl-col-group-equal-height .fl-col.fl-visible-medium,.fl-col-group-equal-height .fl-col.fl-visible-mobile {display: none;}.fl-visible-desktop {display: block;}.fl-col-group-equal-height .fl-col.fl-visible-desktop {display: flex;}.fl-row,.fl-row-content {margin-left: auto;margin-right: auto;min-width: 0;}.fl-row-content-wrap {position: relative;}.fl-builder-mobile .fl-row-bg-photo .fl-row-content-wrap {background-attachment: scroll;}.fl-row-bg-video,.fl-row-bg-video .fl-row-content,.fl-row-bg-embed,.fl-row-bg-embed .fl-row-content {position: relative;}.fl-row-bg-video .fl-bg-video,.fl-row-bg-embed .fl-bg-embed-code {bottom: 0;left: 0;overflow: hidden;position: absolute;right: 0;top: 0;}.fl-row-bg-video .fl-bg-video video,.fl-row-bg-embed .fl-bg-embed-code video {bottom: 0;left: 0px;max-width: none;position: absolute;right: 0;top: 0px;}.fl-row-bg-video .fl-bg-video video {min-width: 100%;min-height: 100%;width: auto;height: auto;}.fl-row-bg-video .fl-bg-video iframe,.fl-row-bg-embed .fl-bg-embed-code iframe {pointer-events: none;width: 100vw;height: 56.25vw; max-width: none;min-height: 100vh;min-width: 177.77vh; position: absolute;top: 50%;left: 50%;transform: translate(-50%, -50%);-ms-transform: translate(-50%, -50%); -webkit-transform: translate(-50%, -50%); }.fl-bg-video-fallback {background-position: 50% 50%;background-repeat: no-repeat;background-size: cover;bottom: 0px;left: 0px;position: absolute;right: 0px;top: 0px;}.fl-row-bg-slideshow,.fl-row-bg-slideshow .fl-row-content {position: relative;}.fl-row .fl-bg-slideshow {bottom: 0;left: 0;overflow: hidden;position: absolute;right: 0;top: 0;z-index: 0;}.fl-builder-edit .fl-row .fl-bg-slideshow * {bottom: 0;height: auto !important;left: 0;position: absolute !important;right: 0;top: 0;}.fl-row-bg-overlay .fl-row-content-wrap:after {border-radius: inherit;content: '';display: block;position: absolute;top: 0;right: 0;bottom: 0;left: 0;z-index: 0;}.fl-row-bg-overlay .fl-row-content {position: relative;z-index: 1;}.fl-row-default-height .fl-row-content-wrap,.fl-row-custom-height .fl-row-content-wrap {display: -webkit-box;display: -webkit-flex;display: -ms-flexbox;display: flex;min-height: 100vh;}.fl-row-overlap-top .fl-row-content-wrap {display: -webkit-inline-box;display: -webkit-inline-flex;display: -moz-inline-box;display: -ms-inline-flexbox;display: inline-flex;width: 100%;}.fl-row-default-height .fl-row-content-wrap,.fl-row-custom-height .fl-row-content-wrap {min-height: 0;}.fl-row-default-height .fl-row-content,.fl-row-full-height .fl-row-content,.fl-row-custom-height .fl-row-content {-webkit-box-flex: 1 1 auto; -moz-box-flex: 1 1 auto;-webkit-flex: 1 1 auto;-ms-flex: 1 1 auto;flex: 1 1 auto;}.fl-row-default-height .fl-row-full-width.fl-row-content,.fl-row-full-height .fl-row-full-width.fl-row-content,.fl-row-custom-height .fl-row-full-width.fl-row-content {max-width: 100%;width: 100%;}.fl-builder-ie-11 .fl-row.fl-row-full-height:not(.fl-visible-medium):not(.fl-visible-medium-mobile):not(.fl-visible-mobile),.fl-builder-ie-11 .fl-row.fl-row-custom-height:not(.fl-visible-medium):not(.fl-visible-medium-mobile):not(.fl-visible-mobile) {display: flex;flex-direction: column;height: 100%;}.fl-builder-ie-11 .fl-row-full-height .fl-row-content-wrap,.fl-builder-ie-11 .fl-row-custom-height .fl-row-content-wrap {height: auto;}.fl-builder-ie-11 .fl-row-full-height .fl-row-content,.fl-builder-ie-11 .fl-row-custom-height .fl-row-content {flex: 0 0 auto;flex-basis: 100%;margin: 0;}.fl-builder-ie-11 .fl-row-full-height.fl-row-align-top .fl-row-content,.fl-builder-ie-11 .fl-row-full-height.fl-row-align-bottom .fl-row-content,.fl-builder-ie-11 .fl-row-custom-height.fl-row-align-top .fl-row-content,.fl-builder-ie-11 .fl-row-custom-height.fl-row-align-bottom .fl-row-content {margin: 0 auto;}.fl-builder-ie-11 .fl-row-full-height.fl-row-align-center .fl-col-group:not(.fl-col-group-equal-height),.fl-builder-ie-11 .fl-row-custom-height.fl-row-align-center .fl-col-group:not(.fl-col-group-equal-height) {display: flex;align-items: center;justify-content: center;-webkit-align-items: center;-webkit-box-align: center;-webkit-box-pack: center;-webkit-justify-content: center;-ms-flex-align: center;-ms-flex-pack: center;}.fl-row-default-height.fl-row-align-center .fl-row-content-wrap,.fl-row-full-height.fl-row-align-center .fl-row-content-wrap,.fl-row-custom-height.fl-row-align-center .fl-row-content-wrap {align-items: center;justify-content: center;-webkit-align-items: center;-webkit-box-align: center;-webkit-box-pack: center;-webkit-justify-content: center;-ms-flex-align: center;-ms-flex-pack: center;}.fl-row-default-height.fl-row-align-bottom .fl-row-content-wrap,.fl-row-full-height.fl-row-align-bottom .fl-row-content-wrap,.fl-row-custom-height.fl-row-align-bottom .fl-row-content-wrap {align-items: flex-end;justify-content: flex-end;-webkit-align-items: flex-end;-webkit-justify-content: flex-end;-webkit-box-align: end;-webkit-box-pack: end;-ms-flex-align: end;-ms-flex-pack: end;}.fl-builder-ie-11 .fl-row-full-height.fl-row-align-bottom .fl-row-content-wrap,.fl-builder-ie-11 .fl-row-custom-height.fl-row-align-bottom .fl-row-content-wrap {justify-content: flex-start;-webkit-justify-content: flex-start;}.fl-col-group-equal-height {display: flex;flex-wrap: wrap;width: 100%;}.fl-col-group-equal-height.fl-col-group-has-child-loading {flex-wrap: nowrap;}.fl-col-group-equal-height .fl-col,.fl-col-group-equal-height .fl-col-content {display: flex;flex: 1 1 auto;}.fl-col-group-equal-height .fl-col-content {flex-direction: column;flex-shrink: 1;min-width: 1px;max-width: 100%;width: 100%;}.fl-col-group-equal-height:before,.fl-col-group-equal-height .fl-col:before,.fl-col-group-equal-height .fl-col-content:before,.fl-col-group-equal-height:after,.fl-col-group-equal-height .fl-col:after,.fl-col-group-equal-height .fl-col-content:after{content: none;}.fl-col-group-nested.fl-col-group-equal-height.fl-col-group-align-top .fl-col-content,.fl-col-group-equal-height.fl-col-group-align-top .fl-col-content {justify-content: flex-start;}.fl-col-group-nested.fl-col-group-equal-height.fl-col-group-align-center .fl-col-content,.fl-col-group-equal-height.fl-col-group-align-center .fl-col-content {align-items: center;justify-content: center;}.fl-col-group-nested.fl-col-group-equal-height.fl-col-group-align-bottom .fl-col-content,.fl-col-group-equal-height.fl-col-group-align-bottom .fl-col-content {justify-content: flex-end;}.fl-col-group-equal-height.fl-col-group-align-center .fl-module,.fl-col-group-equal-height.fl-col-group-align-center .fl-col-group {width: 100%;}.fl-builder-ie-11 .fl-col-group-equal-height,.fl-builder-ie-11 .fl-col-group-equal-height .fl-col,.fl-builder-ie-11 .fl-col-group-equal-height .fl-col-content,.fl-builder-ie-11 .fl-col-group-equal-height .fl-module,.fl-col-group-equal-height.fl-col-group-align-center .fl-col-group {min-height: 1px;}.fl-col {float: left;min-height: 1px;}.fl-col-bg-overlay .fl-col-content {position: relative;}.fl-col-bg-overlay .fl-col-content:after {border-radius: inherit;content: '';display: block;position: absolute;top: 0;right: 0;bottom: 0;left: 0;z-index: 0;}.fl-col-bg-overlay .fl-module {position: relative;z-index: 2;}.fl-module img {max-width: 100%;}.fl-builder-module-template {margin: 0 auto;max-width: 1100px;padding: 20px;}.fl-builder-content a.fl-button,.fl-builder-content a.fl-button:visited {border-radius: 4px;-moz-border-radius: 4px;-webkit-border-radius: 4px;display: inline-block;font-size: 16px;font-weight: normal;line-height: 18px;padding: 12px 24px;text-decoration: none;text-shadow: none;}.fl-builder-content .fl-button:hover {text-decoration: none;}.fl-builder-content .fl-button:active {position: relative;top: 1px;}.fl-builder-content .fl-button-width-full .fl-button {display: block;text-align: center;}.fl-builder-content .fl-button-width-custom .fl-button {display: inline-block;text-align: center;max-width: 100%;}.fl-builder-content .fl-button-left {text-align: left;}.fl-builder-content .fl-button-center {text-align: center;}.fl-builder-content .fl-button-right {text-align: right;}.fl-builder-content .fl-button i {font-size: 1.3em;height: auto;margin-right:8px;vertical-align: middle;width: auto;}.fl-builder-content .fl-button i.fl-button-icon-after {margin-left: 8px;margin-right: 0;}.fl-builder-content .fl-button-has-icon .fl-button-text {vertical-align: middle;}.fl-icon-wrap {display: inline-block;}.fl-icon {display: table-cell;vertical-align: middle;}.fl-icon a {text-decoration: none;}.fl-icon i {float: right;height: auto;width: auto;}.fl-icon i:before {border: none !important;height: auto;width: auto;}.fl-icon-text {display: table-cell;text-align: left;padding-left: 15px;vertical-align: middle;}.fl-icon-text-empty {display: none;}.fl-icon-text *:last-child {margin: 0 !important;padding: 0 !important;}.fl-icon-text a {text-decoration: none;}.fl-icon-text span {display: block;}.fl-icon-text span.mce-edit-focus {min-width: 1px;}.fl-photo {line-height: 0;position: relative;}.fl-photo-align-left {text-align: left;}.fl-photo-align-center {text-align: center;}.fl-photo-align-right {text-align: right;}.fl-photo-content {display: inline-block;line-height: 0;position: relative;max-width: 100%;}.fl-photo-img-svg {width: 100%;}.fl-photo-content img {display: inline;height: auto;max-width: 100%;}.fl-photo-crop-circle img {-webkit-border-radius: 100%;-moz-border-radius: 100%;border-radius: 100%;}.fl-photo-caption {font-size: 13px;line-height: 18px;overflow: hidden;text-overflow: ellipsis;}.fl-photo-caption-below {padding-bottom: 20px;padding-top: 10px;}.fl-photo-caption-hover {background: rgba(0,0,0,0.7);bottom: 0;color: #fff;left: 0;opacity: 0;filter: alpha(opacity = 0);padding: 10px 15px;position: absolute;right: 0;-webkit-transition:opacity 0.3s ease-in;-moz-transition:opacity 0.3s ease-in;transition:opacity 0.3s ease-in;}.fl-photo-content:hover .fl-photo-caption-hover {opacity: 100;filter: alpha(opacity = 100);}.fl-builder-pagination,.fl-builder-pagination-load-more {padding: 40px 0;}.fl-builder-pagination ul.page-numbers {list-style: none;margin: 0;padding: 0;text-align: center;}.fl-builder-pagination li {display: inline-block;list-style: none;margin: 0;padding: 0;}.fl-builder-pagination li a.page-numbers,.fl-builder-pagination li span.page-numbers {border: 1px solid #e6e6e6;display: inline-block;padding: 5px 10px;margin: 0 0 5px;}.fl-builder-pagination li a.page-numbers:hover,.fl-builder-pagination li span.current {background: #f5f5f5;text-decoration: none;}.fl-slideshow,.fl-slideshow * {-webkit-box-sizing: content-box;-moz-box-sizing: content-box;box-sizing: content-box;}.fl-slideshow .fl-slideshow-image img {max-width: none !important;}.fl-slideshow-social {line-height: 0 !important;}.fl-slideshow-social * {margin: 0 !important;}.fl-builder-content .bx-wrapper .bx-viewport {background: transparent;border: none;box-shadow: none;-moz-box-shadow: none;-webkit-box-shadow: none;left: 0;}.mfp-wrap button.mfp-arrow,.mfp-wrap button.mfp-arrow:active,.mfp-wrap button.mfp-arrow:hover,.mfp-wrap button.mfp-arrow:focus {background: transparent !important;border: none !important;outline: none;position: absolute;top: 50%;box-shadow: none !important;-moz-box-shadow: none !important;-webkit-box-shadow: none !important;}.mfp-wrap .mfp-close,.mfp-wrap .mfp-close:active,.mfp-wrap .mfp-close:hover,.mfp-wrap .mfp-close:focus {background: transparent !important;border: none !important;outline: none;position: absolute;top: 0;box-shadow: none !important;-moz-box-shadow: none !important;-webkit-box-shadow: none !important;}.admin-bar .mfp-wrap .mfp-close,.admin-bar .mfp-wrap .mfp-close:active,.admin-bar .mfp-wrap .mfp-close:hover,.admin-bar .mfp-wrap .mfp-close:focus {top: 32px!important;}img.mfp-img {padding: 0;}.mfp-counter {display: none;}.mfp-wrap .mfp-preloader.fa {font-size: 30px;}.fl-form-field {margin-bottom: 15px;}.fl-form-field input.fl-form-error {border-color: #DD6420;}.fl-form-error-message {clear: both;color: #DD6420;display: none;padding-top: 8px;font-size: 12px;font-weight: lighter;}.fl-form-button-disabled {opacity: 0.5;}.fl-animation {opacity: 0;}.fl-builder-preview .fl-animation,.fl-builder-edit .fl-animation,.fl-animated {opacity: 1;}.fl-animated {animation-fill-mode: both;-webkit-animation-fill-mode: both;}.fl-button.fl-button-icon-animation i {width: 0 !important;opacity: 0;-ms-filter: "alpha(opacity=0)";transition: all 0.2s ease-out;-webkit-transition: all 0.2s ease-out;}.fl-button.fl-button-icon-animation:hover i {opacity: 1!
Blessings Of Commitment To God, Large Ranches For Sale In Texas, Cape Cod Baseball Tournaments 2023, Jackson School District Staff Directory, Serious Crash In Hawkins County Today, Articles C