Home Forums Discussions Problems PA and co signing chart

Good Morning.
I have a problem with using a mid-level and how it works in AC. I set the PA to midlevel status and clicked the ?notes can be signed then notify supervisor (ie.for co-sign)? button so his supervising MD name will also show on the chart. That looks great for insurance purposes and the RX prints out with both names which is terrific. However, the mid-level charges are NOT being sent over to the check out station UNTIL the supervising doctor co-signs the chart. This is just not practical. If the supervising provider is busy or not in the building how do I get the patient billed and out the door??!!! Yes, I know I can set the PA to full provider status and the charges go over but the purpose of having the supervising MD 'co-sign' is necessary if an insurance audit is done! PLEASE help

We currently have all PA's set to Provider status in our practice. It depends on where you practice but here in the state of California, supervising MD's are required to co-sign 5% of charts. So for us, setting PA's to mid-level status presents a burden on the supervising PA as they have to co-sign everything.

I would make a template for the PA to use that has the supervising physician information for the plan section of AC ie: "Dr. John Doe, supervising physician".

Find out what the laws are in your state in regards to how many charts have to be co-signed. For those that need to be cosigned, the PA can forward the chart to the supervising MD. We have made a template for the supervising MD that states "I have reviewed and agree with the above assessment & plan" and the MD signs off the chart.

Hope this helps

I had a mid-level access set up and did not want to co-sign every chart, but you may want some of them sent to you. I made a template that said the chart was being co-signed secondary to a technical issue, but in fact had NOT been reviewed by me and the person is independent in this visit. That can be used to quickly "sign off" charts that you don't actually want to sign off. I don't make any guarantees about the legality of this.

Thanks Marty.
5% is the standard here in GA too.
I just really like how the RX looks too with both PA and MD info on it.
Will take your advice and just do template!

Thanks Chris!

Your PA can always add in the notes to pharmacist "written under Dr. John Doe". It shouldn't really matter how the prescription looks as long as the pharmacy accepts it. I haven't had any issues when I write for anything. Should the pharmacy call our office, the staff has been instructed to let the pharmacy know who my supervising physician is if they ask.

Have your PA send a couple charts a day to the supervising physician for signature (that covers 40 patients seen in a day).