feedme Posted January 20, 2017 Share Posted January 20, 2017 Are your charts being signed by your supervising physician? If so what is the significance of the physician signature on the chart? Link to comment Share on other sites More sharing options...
quietmedic Posted January 20, 2017 Share Posted January 20, 2017 Well, technically, very few places actually use paper charts, almost everything is electronic now. In some institutions, supervising docs (or just whatever attending doc is supervising your department) may review your charts, and click something like "Agree with PA's evaluation and treatment of patient". That would be as tangible as cosigning gets today. My actual, "on-paper" SP (supervising physician) at a hospital I was at never reviewed my personal charts, to my knowledge. Other docs may just skim your chart as it passes by (without actually clicking or "signing" anything). In some cases, your SP may do neither of the above, and just trust you did your job right, if that level of trust and experience is there. At least in NY, I do not believe there is a legal requirement for a SP to actually physically review/click or sign something, though I could be wrong. If there is a legal requirement, the significance would obviously be to fulfill the law; Where it is optional, it may be done for billing purposes, or more likely because the institution just wants PA's charts to be reviewed to ensure adequate evaluation & treatment; but it's more likely done for adequate legal protection ("CYA") so the doctor is another step in protecting the institution from lawsuits (heck, that's 90% of why I overchart so much anyway) Link to comment Share on other sites More sharing options...
feedme Posted January 20, 2017 Author Share Posted January 20, 2017 So my company had instructed us to check off the supervising physician signature. So it says "Electronicaly signed by "MD/DO." It this legal? Does this mean that my MD should have reviewed the chart before clicking off that box? I'm in NYS. Link to comment Share on other sites More sharing options...
overthehorizen Posted January 20, 2017 Share Posted January 20, 2017 Cosigning electronically is required in some places depending on acuity, experience, hospital policy or physician policy. You know you are doing well when your charts are merely cosigned with nothing added. You can always recognize a physician who is insecure with PAs. They read your notes, then pick some of the points that you already stated in your note and add them verbatim, unedited, as if their original thoughts and write "I agree with above plus ...." Not except, not including. Just a plagiarized excerpt of my note. Look for this more from recent residency and fellowship graduates. Some physicians feel they have to utter something, anything, no matter how insignificant and noncontributory, in order for them to feel as if they have a superior role. "Yes Miss Daisy, I'm driving below the speed limit." Link to comment Share on other sites More sharing options...
HMtoPA Posted January 20, 2017 Share Posted January 20, 2017 I guess it depends on your system & what EHR you use, but ours allows co-signature by a reviewer in certain instances. For example, when I first started and they were getting my credentialing sorted out, I was in a "supervised" status and all my notes had to be co-signed by my SP - the note was all mine, and said "Signed by [ME]" at the bottom, and just below "Co-Signed by [sP]" just to signify that he had reviewed the note and basically taken responsibility for the care that had taken place. Just like when you had to have your notes signed off as a PA-S. That only lasted a week or two while my credentials were validated, but now I often have notes to co-sign myself - for example, when my patients see the diabetes educator, or the nurse talks to someone on the phone about test results or med refills - these people can't generally sign off on notes because of their clinic roles. This is a completely separate thing than periodic chart review, which would be when your SP reviews a certain percentage of your notes each month as per your supervision agreement. The note is not co-signed or altered or tagged in any way, just reviewed. Link to comment Share on other sites More sharing options...
feedme Posted January 20, 2017 Author Share Posted January 20, 2017 NYS has no regulations regarding chart review. Does not need to be done in NYS, I believe. My charts are not being reviewed at all. I am not sure why I am clicking off on this box? Is this fraudulent documentation? Does this not signify that the MD should have reviewed the chart? Link to comment Share on other sites More sharing options...
DizzyJ Posted January 20, 2017 Share Posted January 20, 2017 Will the SP be electornically signing the note? If you are checking the box and then within a period of time they are actually electronically signing the note, then this does not seem to be fraud. Are you checking it just so the SP doesn't have to go hunt downt he chart and check it him/her self? You should ask you facility the reasoning behind doing this and see what they say. In California I need a 5% chart review and/or 10 charts per month. At one urgent care I work at the SP goes through the stack of my completed charts and signs all of them. I don't know why, but that is what they do. We had zero discussion about any of the patients. At my full time job the SP co-signs certain charts for billing purposes. Link to comment Share on other sites More sharing options...
feedme Posted January 20, 2017 Author Share Posted January 20, 2017 So this signature essentially means that the MD/DO has reviewed the chart? Is there some literature or something that I can read what that signifies? I always thought it meant that we are a dependent provider just like the MD name must be on a RX Link to comment Share on other sites More sharing options...
Reality Check 2 Posted January 20, 2017 Share Posted January 20, 2017 The employer might be using the signature to chart 100% instead of the 85% PA reimbursement which I consider fraud. The doc has to TOUCH the patient in my opinion to charge the extra fee. I have had docs both read, scrutinize and dissect my charts before signing and docs who don't read a word and click "OK". Neither approach benefited the patient. So, I would question the purpose, intent and billing of this situation and then see if you, the PA, will receive any benefit from this futile activity. Will the doc actually review with you any concerns or documentation tips and tricks? If not - never mind, it is a waste of time. Under oath, the doc would not be able to say that he/she actually saw the patient or touched the patient and simply "agreed" with your treatment. So, ask your employer for specifics and then decide if it sounds kosher. Use state regs as backup and check hospital/clinic bylaws for specifics. Link to comment Share on other sites More sharing options...
feedme Posted January 20, 2017 Author Share Posted January 20, 2017 Company had been previously billing incident to / 100% but has since changed but never asked us to stop co-signing. Not sure if I will legally get in trouble for having his name be on past charts? Link to comment Share on other sites More sharing options...
rpackelly Posted January 20, 2017 Share Posted January 20, 2017 The great thing about the new law in Michigan is that it clearly states that no co signatures on any chart, order,or any form are required, and that if a PA signs anything it is just as good as having the doc sign. PAs are not supervised any longer; they work within a practice agreement. Everyone is responsible for their own actions. We will see how this works out in practice but it is extremely encouraging. Link to comment Share on other sites More sharing options...
AbeTheBabe Posted January 20, 2017 Share Posted January 20, 2017 I don't think the doc has to see the patient that day for incident to. To meet the requirements of "incident to" billing, the doctor has to have previously seen the patient, you have to follow his/her treatment plan with no changes, and he/she needs to be in the same building. Something to that nature. We don't do this at my work because it's just not worth the hassle. Link to comment Share on other sites More sharing options...
feedme Posted January 21, 2017 Author Share Posted January 21, 2017 What does the signature mean though? Does this mean that the MD must have touched the patient or just reviewed the chart or just have discussed the case with the PA? Who is authorized to put the sig down? Link to comment Share on other sites More sharing options...
Guest Paula Posted January 22, 2017 Share Posted January 22, 2017 What does the signature mean though? Does this mean that the MD must have touched the patient or just reviewed the chart or just have discussed the case with the PA? Who is authorized to put the sig down? @feedme: Why are you asking us? GO to your employer and pick their brains. The first question to ask is: Why am I required to click a box that says the note was electronically signed by an MD/DO when it is the PA who electronically signed the chart for the lazy MD/DO who are probably getting paid $5000 a month for you to click the box. Link to comment Share on other sites More sharing options...
jcash Posted January 23, 2017 Share Posted January 23, 2017 So this signature essentially means that the MD/DO has reviewed the chart? Is there some literature or something that I can read what that signifies? I always thought it meant that we are a dependent provider just like the MD name must be on a RX You should NOT check that box. If they check the box that's fine but this also allows them to bill under the doctor which gets them more reimbursement. But I'd make the doc check the box, I wouldn't do it. It puts you in a difficult situation if that's checked and there's no proof the doc was even in the chart. Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
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