Wiki Mismatched Providers in the EHR

[saraquinn]

Here is my tricky wicket.....


A provider sees a patient and then at checkout the office staff may be logged in under another provider and they generate the visit summary. This visit summary generates with a different providers name on it from the practice. Is this a problem from an auditing point of view??

Or.... staff log in a lab and they are under another provider and it logs it under the other provider. It was clearly ordered by the original provider.

Our staff are very nonchalant about this. It bugs me.... I just want to know if it will bite me during an insurance audit. I feel like it is sloppy.

 

[LGillstrom]

Mismatched Providers

Yes, this is a compliance issue. Here is why:

1) Liability - if the after visit summary is incorrect or has misinformation on it, the provider whose name is on it may potentially be held liable in court should the patient have adverse effects from medication or treatment, etc. as outlined on that visit summary. This same holds true for labs/xrays/procedures/etc. If the "ordering provider" is not actually the provider who ordered it - - - what is the reason they ordered it if they have never seen the patient (as an example)?? Also, liability.

2) Yes! As an auditor, I can tell you that we DO look at the orders, and make sure that the labs or other tests ordered in the documentation match those billed - and those actually ordered in the system - and to results. If the orders do NOT match, it is considered not ordered by that provider, etc. therefore, it is not billable under that providers name. (depending on the systems used, of course, so this varies from facility to facility)

3) Audit Logs - if your providers are listed in the system in the audit logs, this is a permanent record, and is considered admissible in court! It could definitely become a complication for your organization in the future.

4) HIPAA/IT Security violations - If the providers are leaving terminals and not properly signing in/out or locking the terminal (thus another provider can walk up and use it) this means ANYONE can walk up and use it - and create documentation in that providers name...or look up someone under that providers name! This is a potentially HUGE HIPAA/IT Security/Malpractice violation (in an extreme situation, of course, but it could happen!!)

My recommendation: Education them to long in and out when they leave the terminals - - - EVERY TIME! and spot-check to make sure they actually are - and have penalties in place for those who do not.



Hope this helps!!