Wiki Documentation of Encounter/Ethics

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AliMontone

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I am practice manager for a solo practitioner and my job is now in jeopardy due to this issue. The physician states that his newly hired MA as well as his sister (not medically trained) and the new front desk employee can document the entire encounter. Cc, hpi, pmfsh, ros, occasionally the exam, as well as "figuring out the dx" from the info they gathered at intake. All of this is done without the presence of the physician in the room. He makes a brief appearance with a new patient to tell them they need surgery or an injection and the MA is left to do everything else and document or figure everything else out. They are also removing casts, sutures, and reapplying casts. He asked me if I was refusing to do this and I said yes, to do so would be fraudulent and claims would be upcoded as he is not actually documenting anything. He is spending on average 4 minutes with a patient and we see appx 40 pts a day..1 physician.. they also went over my head and added the MA in the EMR (not even a certified MA) to act as his delegate to write, sign and send rx to the pharmacies without his actual signature or review. I have flatly refused to condone this and he informed me that due to the fact that my interpretation of the rules, regulations, and laws is not how he sees it, that I will be transitioned out..am I completely and totally wrong? Or is this as unethical as it comes? His philosophy is quantity not quality and I can get on board or not...I do have my explanation to him in writing through email, with his response stating that he still needs myself and the staff to continue completing the documents including the HPI. I just need to know if I'm completely misinformed here. I am either going to quit or be fired in the next few days.
 
I do not feel you are mistaken. Go to your state medical licensing board, they should be able to provide you with clear instructions. However the only information that can be obtained by ancillary staff is the ROS but the provider must document that this was reviewed by him with the patient.. This is stated in the physician guidelines. The exam must be performed by the billing provider, and the diagnosis must be destined by the provider and written in his own words.. This is stated in the 1st quarter 2012 coding clinic. And non qualified health professional is not allowed to interpret reports, labs or exam findings.
 
This is well beyond a coding/claims issue. This is a patient safety issue and I agree with Debra, go to the state board. There are providers in jail right now for delegating work to non-qualified employees and falsely representing the services as their own. Giving anyone his information and ability to send in prescriptions could likely cost him his license, especially if there are bad outcomes.

Some of the potential push back you may get would be they are acting as scribes, which when done correctly is acceptable. Based on your description though, that is not what is happening. Support staff can obtain and document the chief complaint, ROS, PFSH, and vitals. If properly trained they can perform and document some of the other ancillary services.

Interesting case to research, they too felt quantity was more important than quality.

http://www.kansas.com/news/article1046234.html

I wish you the best and am very sorry to hear you have been placed in this terrible position.

Laura, CPC, CPMA, CPC-I, CANPC, CEMC
 
Thank you for your replies. He has me thinking that I'm the one who is incompetent and providing false information to the staff! It is not a good environment and if I wasn't a single mother with two children I would already be gone. I am making sure I stress daily to the staff not to perform these tasks and he consistently threatens them. I will take the proper channels to report him. I have never in my 20 years of healthcare experience encountered such an unethical physician.
 
And definitely no scribing going on here as I myself have had to do intake and was "neglecting" to do the HPI and was reprimanded because he didn't have a good enough explanation as to why the patient was being seen. On average the person doing the intake has to spend approximately 15 minutes gathering info, taking vitals, removing sutures or casts and then reapplication of the cast after he xrays. I refused to do this and this is what prompted him to tell me I would be transitioned out because of my insubordination...
 
Wow, Ali, I'm sorry you're going through this.

I agree this is unethical and unlawful.

Please keep us posted of how it turns out!

Lena
 
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