ohiovolffemtp Posted December 4, 2016 Share Posted December 4, 2016 Is anyone else seeing this? At both of the hospitals where I work, different hospital groups, different national staffing companies, a requirement has been implemented over the past 6 months or so to have an attending's name on every chart. At a minimum, the attending puts in a "I was available for consultation" note. In one hospital the physician must be listed as the attending, even if they never saw the patient. It seems to be so that the ED visit can be billed at the 100% incident to rate vs the 85% rate for the PA/NP alone visit. Doesn't seem to be affecting the actual flow of how much the doc is actually involved with the patient. That seems to be driven more by the doc's preference. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 4, 2016 Moderator Share Posted December 4, 2016 1 place I work the docs have to sign every chart within 1 month and they do put the "I was available for consultation" note in there. another place I work does zero PA chart review as it is not a state or hospital requirement. . Link to comment Share on other sites More sharing options...
RuralER/Ortho Posted December 4, 2016 Share Posted December 4, 2016 Docs cosign all my notes as well. We are typically double coverage, but frequently don't see the patient. Doesn't impact my flow. Often they aren't signed until some time later. Link to comment Share on other sites More sharing options...
Guest ERCat Posted December 8, 2016 Share Posted December 8, 2016 I have everyone of my notes cosigned as well. Most of the docs just put a " I was available in the emergency department for consultation" blurb. Which to me is fine if they never saw the patient, but sometimes it annoys me if they actually saw and evaluated the patient but didn't say that they did. Other doctors go in and see the patient and put an entire medical decision-making paragraph. But all of my charts are signed, or are supposed to be at least. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted December 8, 2016 Moderator Share Posted December 8, 2016 ER cat. if the doc sees the pt, put it in the chart Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 8, 2016 Moderator Share Posted December 8, 2016 comes down to JACHO regs, and billing regs, and a hospital trying to be 'safe' in both total BS need full practice authority... Link to comment Share on other sites More sharing options...
Guest ral Posted December 15, 2016 Share Posted December 15, 2016 No big deal. Doesn't diminish my role or value in the ED. If they want to have the Pope come in and sign the chart as well, I really don't care. Let me do my work, make sure my paychecks cash, and we will get along just fine. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 15, 2016 Share Posted December 15, 2016 My big question - is this legal or even ethical? Can the PA get in trouble for fraudulent billing practices? Another vote for independent practice rights...... One office setting I was in - the billers brought me the physical bill sheets (long before the days of pass through billing in EMR) - they made recommendations on billing corrections but I physically had to circle the changes and initial them. The billers said it was fraud for them to make changes. Another office - I found out my 99213s were changed to 99214s without my knowledge. My dictation always supported the higher billing but I wasn't notified. That made me feel hinky. What was my defense if Medicare came auditing - "Um, I didn't know it was changed. I billed a 99213..." Sounds stupid and asinine. So, I wonder if the ER/Hospital wanting doc notes/signatures is all above board and everyone is following the rules? Is there a clause a PA can put on a chart? - more disclaimers - palm to forehead --- "I, Jane Doe, PA saw and managed this patient using my certified practitioner skills and documented to the best of my knowledge. Whatever my employer's billing department does is beyond my control" Just brings up a lot of ethical and legal questions in my mind. Link to comment Share on other sites More sharing options...
slolar Posted December 27, 2016 Share Posted December 27, 2016 Just went through this with my group. Here in MI, if MD signs the charts and SEES the patient, reimbursement for BCBS and Medicare increases from 85% to 100%. RVU and billing is always the same irrespective of the provider. It's just that BCBS and Medicare will only *reimburse* PAs at 85%. So now my group requires all admitted patients to be seen by MD and put on a note. Seems silly to me, as these are LOW risk compared to some of the things I see and discharge without my SP seeing. I can only imagine it has to do with the $$. Sara Link to comment Share on other sites More sharing options...
montanapup Posted December 3, 2018 Share Posted December 3, 2018 Reviving this thread as I have a question regarding billing in the ED Observation setting. APCs staff the unit, all MDM by the PA/NP. Rounding in the mornings, otherwise, if no questions/concerns, disposition by APC. All charts with attestation once complete. I'm trying to figure out how and under who this is this billed. It's all technically Outpatient. Everything I'm searching for seems to indicate it's under the Attending physician which leads me to believe that billing is under the physician as well even if the patient's care has been entirely under the APC for the duration of the stay. I'd love some clarification if anyone on this forum has some experience with this as it doesnt demonstrate my productivity, capture my worth or give me a cut of the RVUs generated. Thoughts? Thanks! Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.