Add Observer Signature Service with airSlate SignNow

Add observer signature service

[Music] welcome to the code cast podcast real-world insights for your daily medical coding and billing processes and now here's your host Terry Fletcher hello everyone and welcome to the code cast podcast today welcome to August my name is Terry Fletcher it's crazy how summer is just flying on by today is our 93rd episode so we are going to try to focus and keep my podcast under 30 minutes I know I've been going a little bit long lately apparently I've got a lot to say but I'm gonna keep this one short and sweet today at least I'm gonna attempt to I always try to do a 30-minute threshold and sometimes I'm around 2025 minutes and sometimes I've gone up to as much as 37 minutes or higher but I know a lot of you listen to this on your way to work or home from work and I just want to make sure that I don't lose you during most of it so we're gonna try and keep our time thresholds on track today and also because I want to get outside and join the rest of my weekend because you know I do pre record these I want to go ahead and get started so our topic today comes from a question I receive from the editor of Part B news magazine so I'm a contributor for them quite a bit because I do a lot of work with decision health and the writer wanted me to comment for an article he was writing on physician Late signatures and I think what's interesting about some of the topics that I present here on the code cast is the fact that we even need to talk about it so when a compliance issue comes up meaning not following the published guidelines then we have to talk about it and your credibility and your reimbursement and your reputation as a physician and as practice comes into play when you see some of these topics that I present such as the one on critical care the one on how to document time and just things not followed and so today we're gonna really talk about that physician late signatures meaning that they're authenticating a record after it's already been billed or even before it's been sent out but after the date of service and that's a problem and then also I have a second part of today that there is a it I guess you'd call it a compliance issue but I was reading the Australia Journal of Medicine and the concept they're talking about when I bring it to your attention you're gonna be like oh my gosh I can't believe some of the most basic ideas contribute in such a big way to patient safety and outcomes so the second half of the show you'll hopefully see an eye that isn't too small and isn't too trivial to make a difference in the healthcare field or any field for that matter and so if you ever have any kind of insight that you want to share with your employer you should because it's amazing to me some just you could think they're just minuscule or you know unimportant things that you want to bring up but you'd be surprised how important they can be in the big scheme of things and I'm going to kind of share what that is with you after a bit so the first thing we want to talk about again is our late signatures so the question that came in was Terry I have a question about late signatures on documentation so I've been hearing about providers signing their notes a very long time after the encounter weeks later sometimes even months later and even sometimes turning them in unassigned on an ADR so and let me just explain one ADR is real quick so medical review additional development requests those are called ADR process so when a claim is selected for medical review from a Medicare payer a medical review for additional development requests that's the M R ADR is generated requesting medical documentation be submitted to ensure payment is appropriate basically they're asking you to approve medical necessity before we pay you it's almost like a prepayment review documentation has to be received within 45 calendar days to review and payment determination and then why do they do this this ADR well whenever the payer and I know CGS and yridian are big you know proponents of this they can select a Medical Review and generate an ADR and basically they're trying to make sure that claims when elements on the claim basically match the parameters of a prepayment audit suggested by the payer or additional information about certain types of edits that look like they're gonna be part of this encounter they can actually generate that so now what he's asking me this writer from decision health and Part B news is he's saying that even when they're asking for additional information they're not signing their record so as you know CMS guidance and there has said that they're really not supposed to do that but I'm told and actually this writer also told within his email that when auditors catch it as a rule they generally just let the provider attest to it and let it go their signature well not this auditor if I don't have an authenticated or signed record that is one of the basics of Medicare documentation so his question was how does this really work and you know he feels that a super late signature which that's a I don't know if that's a technical term but he says he feels that's fraud well I don't like to use the f-word in anything I talk about unless there's intent a lot of times I think that it's just physicians will help providers of any kind getting lazy in being compliant in the medical record and so we have to make sure that we are efficient and not just letting it go and this is a question I get a lot and so it's a compliance issue for sure those surrounding rules for the signature on a note come from the general documentation guidelines so the main concern and this is one I often hear from billing staff relating to the timely completion of medical records is about making sure that the record is closed out and authenticated before it is sent to the payer so and many of the webinars and webcasts and seminars that I attend and I actually also present here are some of the information that Medicare constantly talks about and they actually put it in their chapter twelve of their manual as well so it says first of all the medical records should be complete and legible well EMR is taking care of the the legible thing completes another story number two the documentation of each patient encounter should include the reason for the encounter in the relevant patient history physical exam findings and prior diagnostic test results assessment and clinical pression impressions or diagnosis a plan for care and the last bullet is a date and legible identity of the observer so when you fail on any level there of the documentation guidelines you're gonna have a problem because again why the issue of legibility that's been addressed and increased by increasing ocean of electronic health records completion of the record through the inclusion of proper documentation and signed dated with signatures still is a concern so what does it mean for a medical record to be complete first of all is the record complete when it contains the documentation of the patient encounter but is not sign and dated so as you know you should not bill for an office visit or other service until documentation on file supporting the level of service indicated for billing is complete the files not complete until the proper documentation is accompanied by a dated signature so now the question becomes how long do you have to sign and date the record in order for it to be accepted by Medicare so the question is most important because the EMR HR system that you're using and a lot of the ones that I work with do not allow you to backdate the signatures which thank God so as I'm auditing I know exactly when the physician's signature was actually authenticated or when it was actually performed or entered into the system and so the question always comes up when you know how long is too long after the care is provided to put in that signature because I have to talk to the administrator about this that it's time-stamped if you go to the website of the Medicare carriers so a Medicare administrative contractor you might find the answer so the policy manual is kind of vague when it talks about this as far as how soon are they supposed to document the signature or sign the note and so it and also timing can vary from region to region but here's what CMS says and this is a quote from the chapter 12 of the manual it says the service should be documented during or as soon as practicable after it is provided in order to maintain an accurate medical record meaning that they do not want the physician to forget details by waiting to sign off on the note also some payers have put on their websites their own interpretation or what they enforce some give reasonable direction like WPS Medicare this is an illinois in wisconsin which states a reasonable expectation would be no more than a couple of days away from the service itself I wish they would have been a little bit more technical like giving the exact hours a couple of days seems so lay terms nuridium and that's what we have here in California this is one of the biggest Macs in the country they state and they're specific in most states are in most cases the notes would be signed at the time services are rendered and Palmetto is a little bit more direct they say providers should not add a late signature to the medical record beyond the short delay that occurs during the transcription process it is understood that there are circumstances like waiting for transcription to be complete that might preclude signing the record at the time of service but in general it is best to sign the record at the time of the service not within a day or two at the latest if not within a day or two at the latest I also educate my clients that signatures beyond a couple of days increase the likelihood that a claim will be denied because medic medically necessary documentation will not be accepted as being present due to this signature and date to removed from the time the care was provided and this is really costly in an audit so for example if every note that had a signature older than three days after a service was provided was not accepted by your Mack carrier then the provider's documentation of work that was done at the time of the visit wouldn't also not be allowed as a result there would be no accepted documentation for the visit and then they'd ask for refunds and they would not even give you any payment at all if you have you received one because and at a stations statement basically saying what was done was also added at a later date so I have a kind of a general rule for my clients or they don't need to be my client so maybe this seems a little bit harsh but this is what keeps my clients and anyone who's a potential client and hopefully those of you on the the code cast are actually enforcing this as well in your practice I make sure that my clients know that I enforce a policy that holds all of their providers in their offices and Clinics to a standard time period of not more than 36 hours to have a signature on the chart and I'm really strict about it and actually I think I'm giving them quite a bit of leeway with three days if they do not want it adhere to the policy I drop them as a client so I have to be able to support and appeal to any record that is questioned and without mandatory policies like this it can give physicians too much rope to basically hang themselves out to dry and accountability is key so it's probably more information that you wanted on than on this topic but and it sounds like I'm angry today which I'm not just so you know but it just this is a topic that drives me crazy because to me it's common sense sign your note authenticate your note and so that that's where it's been a problem the response I got back from Rob on this he said this is absolute great Terry clear and through thorough are you planning to podcast on this because I think he just written that you've just written the script well guess what yes i i'm podcasting on that and he also said i hear what you're saying about the max he also noticed that no Rhydian recently added further delays may require an explanation and he's like this is hilariously vague because you can just see a doctor basically sitting there and saying okay why didn't I sign this and so I've been involved in several audits where all the documentation was actually adequate but the Bret this it wasn't signed and so it was awful because if it's not signed you've got a problem and this can lead to huge compliance issues okay so the next thing I want to get to and this one is kind of amusing to me but before that the code cast is also brought to you today by stranger things netflix.com ford slash stranger things and Victoria Salman Amazon and New York Times bestselling author check out blood for blood and nothing to lose Victoria Salman author calm also find her as a co-host on crime girl gang true crime true crime podcast on iTunes and YouTube I think it's really funny that I'm getting all these true crime podcasts sponsoring my show I'm kind of liking it actually gives us a little bit of an edge don't you think and my shoutouts this week before I get into the second part we're looking at hello to Yolanda and Marla ray Gretta Jennifer Eric and a Ric and Jeanne Gordy Tony and Ruth Ruth a family got your name and so just really appreciate all of you and on all of my social media platforms saying hi or giving me some positive feedback so another thing that came up and this is from the Journal of American Medical Association from Australia so there was a doctor that made a decision in a surgical room and so in a no are that he decided to put his name on his scrub cap and it's actually changing safety in hospitals around the world not just in the United States and so when I was reading this article it basically was talking about you know we get so used to our everyday lives we rarely stop to question just the simple things so after all if they remain the same for so long how do you even know to how you can improve and prove them even more well in an attempt to avoid confusion during some surgical operations there was an Australian anesthetist dr. Rob Hackett he decided to wear a scrub cap with his name on it Rob anesthetist and everybody was like did you forget your name and he put it in big letters and the hashtag theater cap challenge is an initiative from the patient safe Network in response to concerns about how easily avoidable mistakes and poor communication are contributing to rising adverse effect events for patients in the hospital setting so this has been adopted around the world now and just in the last three to four months with studies from the US and UK demonstrating how this simple idea can decreased human errors in health care so think about this so there was a lot of snide remarks and everything basically saying why do you feel like you need to put your cap on well the reason is is that there's an argument that having the names on their head cap you know the cloth ones can save vital seconds in life-and-death situations so basically you can reduce delays and misidentification that occur when clinicians can't recognize or can't remember the names of their their colleagues and they call it in the operating theatre that's why it's called the theater cap challenge but the one physician was saying that he went to a cardiac arrest patient in a surgical suite he called it his theatre where there were 20 people in the room and he said I struggled to even asked to be passed some gloves because the person I was pointing to thought I was pointing to the person behind them and so he said it's so much easier when you can coordinate when you know everyone's name and their role within a surgical unit and it also is creating some camera and it's great for patience as well but the thing that's interesting is that the UK did some studies they shown increased name recall among staff from 42 to 85 percent increased name and role introductions during this surgical safety checklist by doing some of these things and how it also increased the efficiency and they said first of all when it comes to patient especially women who are having cesarean sections in particular they're benefiting from reassurance of knowing the names and positions of every staff member around them they're also now getting into reusable caps not just the paper ones because a 20 they call them again a 20 theatre hospital I saw those people over and over in Great Britain we love you but boy you talk you call things some funny things but they said a 20 theater hospital will discard over a hundred thousand disposable caps every year and caps are made from viscose which is a substance whose production is primarily particularly harmful to the environment so now they're trying to have them cloth so that they wash them and give them back to somebody but a hospital of that size also could spend somewhere in ten thousands of dollars every year on disposable caps as well but the operating rooms and the World Health Organization's safety checklist that now has adopted this as well they try to and they're actually they've trying to put in a requirement that requires all staff to introduce themselves prior to surgery and the reason that this is important because it was never enforced is that this section of the checklist was usually disregarded and so when it's done properly it's it you know and some people are laughing in the operating room you can tell that it's not done regularly if they're you know kind of laughing about it but you have to know who's in command who's doing what because if you don't know who the person is that's providing certain services that can hurt people possibly even kill people as somebody who has to get her hours for nursing in a surgical setting every two years I've noticed that sometimes I will be observing instead of actually assisting in a surgery and the surgeon will look up this is the one who weren't participating in this and they'll look at somebody who basically is an intern or a tech or an anesthetist and ask for an instrument when it's not their job and so they'll just look at them like what are you talking about so then they'll go to the assistant surgeon or the the person who's actually assisting in the procedure and say is it you and they spend so much time trying to figure out who's actually in that that.oh are setting that it just becomes such a problem so it's really important that you know everyone remember it's kind of like hello my name is and introduce themselves but to have that on their actual hat or their their surgical you know helmet whatever you want to call it it's really important to not only the patients but just think of the efficiency now in there from that little thing just put your name on your hat and put it make sure that on your scrub hat that your cap I guess it is that it can save patients lives because the doctor the surgeon only has to look up now see who it is make a comment and you know say I need this and it's all good so something that trivial or that little believe it or not can make a difference and so if you have ideas about that in your office just like I talked about with professionalism and waiting room changes and just little things you you want to bring it to your you know practice attention even something is turning up or down the the thermostat one degree is gonna make a difference things like that make a difference okay so my personal tidbit this week it has been brought to my attention thank you Tony that you may not be aware of a service that I offer that regards a personal business coaching so I've received an inquiry this past week from a code cast listener and yes this is a service I do provide since then I've had that inquiry I've had three people asked me the same thing I think you're all anticipating my business collective podcast so thank you for those who have asked and contacted me directly and I've also now engaged my services so if you are interested in that service yes it is a fee for service so contact me and pricing but if you need to know and have questions and how to venture out on your own I'm happy to offer you coaching advice services insight some tools just to get started I have over 32 years in the business of health care being on my own is an entrepreneur for the last 22 I've made every mistake possible corrected those mistakes with better choices and I really have an understanding of the process probably better than anyone I know so just keep one thing in mind I do try to keep things positive but there's gonna be some things in business that you may not like to hear so you need to listen to all of it the only way to really understand and learn is to listen and hear what's being said reflect on it write down some questions you have and then come back to it again for more detail and insight and then you'll end up deciding if you know you really want to work for yourself and it'll all be worth it and so I hope you trust me on this and really you know kind of engage if you're interested it's really a great service that I started doing a few years back and I get an occasional person here and there and it's just it's really picked up lately so thank you again for anybody who's asked about that I just want to make sure that we've given you the insight there so that's a wrap for this episode everyone make it a great day and until next time thank you for listening to the podcast podcast for more information on medical coding billing auditing and compliance including how to hire Terry follow Terry on twitter at terry coder 1 or visit her website at WWF le tche our net podcast producer Joe Kuzma music producer de Sasson music [Music]