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Signing off on patient encounters: What's your policy?

MGMA Stat - March 8, 2018

Financial Management

Nick Fabrizio PhD, FACMPE, FACHE
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The processes and practices of providers signing off on their patients’ encounters vary widely regardless of group size, specialty or organizational affiliation. When charts are not closed in a timely fashion, the medical group and the provider lose money from billing delays while leaving the door open to omissions or inaccuracies in documentation. Many organizations develop elaborate communication strategies to deal with outliers and have penalties for those who break the rules.

In a March 6 MGMA Stat poll, 79% of respondents indicated that their providers must sign off on patient encounters within 72 hours. Approximately 59% said that providers must sign off within 48 hours and 30% reported it must be done within 24 hours.  

Comments from survey participants focused on the penalties for noncompliance. Those penalties included not calculating the wRVU credit or deducting wRVUs, requiring providers to pay a predetermined amount of money per chart as a fine or terminating repeat offenders. Other methods to assist with chart sign-off compliance included:
  • Sending reports out to providers at the end of each day with the number of open charts
  • Withholding billing for services, resulting in loss of provider pay for those services
  • Withholding paychecks until charts are completed
In my experience, providers in a hospital or health system sign off on their notes faster than their private practice counterparts, on account of their organization having more policies and procedures governing the process. Noncompliant providers may also face suspension of hospital privileges or more stringent financial penalties as part of their employment contracts.  

Many respondents commented that they do not have an issue with their providers completing their notes by the end of the day. Others noted that they have a process for working with problematic physicians to change behaviors, hold ongoing meetings with leadership to address delinquencies or employ scribes to help facilitate the completion of the note. 

While penalizing providers is one method to address this issue, it’s important to ask how are practices helping providers complete their notes in a timely fashion? This includes educating providers and staff on the necessity of timely chart completion, providing ongoing training in best practices using the EHR and finding ways to optimize nonphysician staff to help in chart completion.  

To learn more, check out MGMA's consulting services

 
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About the Author

Nick Fabrizio
Nick Fabrizio PhD, FACMPE, FACHE
Consultant MGMA Consulting

Nick A. Fabrizio, PhD, FACMPE, FACHE, is a consultant with the MGMA Health Care Consulting Group. He has more than 20 years of practice management and health system experience in private physician and large medical group practices, for-profit and non-profit hospitals and health systems, academic medical centers, physician faculty practice plans and ambulatory care networks. His primary expertise is in physician practice management and managing complex physician-hospital relationships.

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