# Provider REFUSING to sign documents prior to billing



## Chief2578 (Aug 16, 2017)

I work for a small specialized practice. I have a doctor that refuses to sign her op notes prior to billing, if at all. I have provided references to e-signature requirements and am looking into HCA guidelines for Utah. I have asked for a signed letter stating that she accepts liability of billing without signed documents. I have not received that yet.
~What other guidelines/policies can I provider her?
~What can I do to prevent anything coming back to me? 
~What other fix action is there?


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## Chelle-Lynn (Aug 16, 2017)

Here is a good reference with CMS from the Learning Center.  It answers questions and provides links to the CMS Manual for the specific guideline.

https://www.cms.gov/Outreach-and-Ed...gnature_Requirements_Fact_Sheet_ICN905364.pdf



Insufficient documentation errors identified by the CERT RC may include: 

1. Incomplete progress notes (for example, unsigned, undated, insufficient detail) *2. Unauthenticated medical records (for example, no provider signature, no supervising signature, illegible signatures without a signature log or attestation to identify  the signer, an electronic signature without the electronic record protocol or policy that documents the process for electronic signatures) *
3. No documentation of intent to order services and procedures


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## Chelle-Lynn (Aug 16, 2017)

Here is one more link for the provider.  Without a signature on the medical records the services are not verified and can be considered fraudulent billing.  Hopefully this will help your provider understand the importance of compliance as it can cause significant repercussion financially and legally.

https://www.cms.gov/Outreach-and-Ed...wnloads/CERTMedRecDoc-FactSheet-ICN909160.pdf


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## arrana (Sep 25, 2017)

Chelle,

Do the CMS documents you linked apply to all payers, or just Medicare?
I have a provider questioning if he, as Chief Medical Officer, can sign the notes of an MD who has left the practice but failed to sign her visit notes. I advised him, with a link from the CMS IOM manual for signature requirements, that we cannot submit any of these claims. He is asking about payers other than Medicare - if the same rules apply.

Thanks for any input you may have.
Arrana


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## Chelle-Lynn (Sep 25, 2017)

Most carriers will adhere to CMS/Medicare guidelines, especially in these types of areas.  I would not recommend billing for any services not signed by the provider who rendered the care.  A Chief Medical Officer was not present at the time the care was rendered and is taking a big risk by "signing" these records.  You will need to review your situation with your offices Compliance Officer for specific recommendations before moving forward.


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## arrana (Sep 25, 2017)

I completely agree that the services should not be billed, for the reasons you state. 

Thanks!
Arrana


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## CatchTheWind (Sep 27, 2017)

Chief2578: The only action you can take is to state that you cannot bill them until they are signed.  I know this could cost your job, but better to lose a job at which you are being asked to commit fraud than to continue to be a party to the fraud.  

I don't believe a letter accepting liability would do any good; billers are also liable for any fraudulent billing they send out.  (This would be like sending you out to rob a store, but first writing a letter accepting all liability for the act!)


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## mcpalmeter (Sep 29, 2017)

There is a difference between signing off on a record to close it from an administrative perspective and signing it as the author of the note when one was not in fact the author of the note.  No one other than the author of the note can attest to the details of the service provided.  In addition, the chief medical officer cannot sign off on a resident's note or a note provided by allied health professionals unless the chief medical officer truly provided the required level of supervision that he/she is attesting to.  We try to include language in physician contracts about completing their records before they leave.  Sometimes it takes a threat of reporting them to the State Board of Medicine to get it done.

Maryann



arrana said:


> Chelle,
> 
> Do the CMS documents you linked apply to all payers, or just Medicare?
> I have a provider questioning if he, as Chief Medical Officer, can sign the notes of an MD who has left the practice but failed to sign her visit notes. I advised him, with a link from the CMS IOM manual for signature requirements, that we cannot submit any of these claims. He is asking about payers other than Medicare - if the same rules apply.
> ...


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## arrana (Oct 10, 2017)

Thanks for your reply Maryann!

Let me clarify. Our CMO is only locking notes from an administrative perspective, he is not adding to or changing any of the rendering providers documentation, other than to add a statement that he has reviewed the note left unlocked by the provider upon departure from the practice. If the documentation doesn't support billing, no claims are created. If the rendering provider documented sufficiently to _technically_ support billing (but possibly missing a key element, like an exam), and left the note unlocked, the CMO is locking with the intent to bill. The bills would be submitted under the rendering provider's name and NPI, not under the CMO's name and NPI.

From all my research I still believe this to be at best bordering on fraud. I have not been able to find anything, other than hearsay, that it is okay to submit these claims. Any credible sources to prove me wrong or right are very much appreciated. Obviously I'd like us to get paid for these 40+ visits, but I am not willing to commit fraud to do it; I also don't want to potentially lose my job if there is a directive that I refuse (hasn't come to that, and hope it doesn't).

Thanks,
Arrana


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