Practice Management Alert

Question: The Pennsylvania Medical Society states that if a PA prescribes medications, the doctor must cosign the note within 10 days. I always have my doctors cosign the notes to show they participated in the patient's care on an ongoing basis, but some of the physicians in my group do not feel it is necessary. Is there a Medicare or other requirement that a physician co-sign office visit notes when the physician assistant or nurse practitioner performs the service?

Pennsylvania Subscriber

Answer: The regulations for having physicians cosign notes varies by state. You'll need to check the nonphysician practitioner (NPP) rules in your state, as those will govern when you need the physician's signature.

This is not a CMS or payer requirement, but rather a state regulation.

As you noted, in Pennsylvania, if a physician assistant (PA) does not prescribe medication, the state does not require co-signed notes but does require a co-signature if medication is prescribed.

Best bet: You should go on your state's Web site and find the information for nurse practitioners, physician assistants, clinical nurse specialists, etc., (those you employ as NPPs), and look up the co-signature requirements for your state.