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Which is more important: Having a chart co-signed promptly by a physician regardless of whether that doctor is listed as the overseeing physician that day, or leaving it open until the overseeing physician can sign it?
Q: When I am out of the office and my physician assistant is seeing my patients while under the supervision of one of my partners, which is more important: having the note co-signed promptly by a physician regardless of whether that doctor is listed as the overseeing physician that day, or leaving it open until the overseeing physician can sign it for Medicare compliance and auditing purposes?
I ask because I often come across unsigned notes several months later, and I have been reflexively signing them. My office manager, however, says that this constitutes fraud because I was not physically in the office when the patient was seen, so we cannot bill under one physician's name and have another sign the chart. Since we cannot have it both ways (one partner doesn't sign promptly), which is least likely to land us in hot water?
A: The obligation of physician supervision over physician assistants varies from state to state. Depending on the state, the physician may or may not need to be physically present and may or may not have to countersign the chart within a given period of time.
If your state requires a physician to be on the premises, that physician must sign the chart in a timely manner. If your state merely requires the physician to countersign a physician assistant's notes as proof that he or she has reviewed and approved the care, the doctor who does so should sign the chart on the day that that review has occurred. The review should occur within the time frame required by state law.
Engaging in dishonesty in the preparation of a medical chart is never acceptable, and one form of dishonesty is no better or worse than another.
Send your practice management questions to firstname.lastname@example.org (please include your regular postal address). Answers to our readers' questions were provided by Judy Bee, Practice Performance Group, La Jolla, California; Keith Borglum, Professional Management and Marketing, Santa Rosa, California; and Steven I. Kern, Kern Augustine Conroy and Schoppmann, Bridgewater, New Jersey.