akfrog224
New
Hello,
I have a question regarding documentation responsibilities.
Here is the situation: a patient is seen for massage therapy, ultrasound therapy, routine injections, lab draws ect. by ancillary staff (medical assistant, massage therapist, lab tech, imaging tech) clinical documentation is entered by the staff member who performed/provided the service. Is it the supervising providers responsibility to review the documentation and finalize/lock the note so that it reads "electronically signed and locked by Dr. Sally"? if they are the billing/rendering provider?
My instincts are telling me if the doctor is the billing/rendering provider then it is their responsibility to review and finalize the clinical note. I am unable to locate any policies/procedures on this and have a provider saying they dont have to review or lock a note when the services were performed by ancillary staff (a medical assistant, or imaging tech).
Please advise.
Thank you in advance.
MP
I have a question regarding documentation responsibilities.
Here is the situation: a patient is seen for massage therapy, ultrasound therapy, routine injections, lab draws ect. by ancillary staff (medical assistant, massage therapist, lab tech, imaging tech) clinical documentation is entered by the staff member who performed/provided the service. Is it the supervising providers responsibility to review the documentation and finalize/lock the note so that it reads "electronically signed and locked by Dr. Sally"? if they are the billing/rendering provider?
My instincts are telling me if the doctor is the billing/rendering provider then it is their responsibility to review and finalize the clinical note. I am unable to locate any policies/procedures on this and have a provider saying they dont have to review or lock a note when the services were performed by ancillary staff (a medical assistant, or imaging tech).
Please advise.
Thank you in advance.
MP