APN logs in under Doctor's name and charts. What do I do?

[StealthRN]

Just a general question about this. I saw this where I work and at first I thought a doctor had logged in and forgotten to log out, but then his practicianer came out of the patient's room and continued to use the open, logged in, charting system to document the visit and enter orders.

My gut tells me this is ILLEGAL. After all, any person be it the hospital staff, the insurance company, medicare medicaid, etc etc... paying the bill or auditing the chart or carrying out or reacting to the physician's signed documentation would believe it came directly from the physician when in reality the doctor has given his log in information to his practicianer and she was entering data under his name.

I am troubled by the potential problem this could present and it's obvious that it's being done as an acceptable standard of operations for this physician, his staff, and perhaps even the hospital knows about it.

Someone please advise.....

[BuckyBadgerRN, ASN, RN]

Maybe it's how the physician wants it done. This really sounds like a "mind your own business" type of scenario, it's not something you'll be going down for

[SierraBravo]

This scenario is bad on every level. Like you said, it could be construed as insurance fraud because the physician isn't actually seeing the patient. Does your institution have an anonymous tip line? Ours does. If you have access to an anonymous tip line, use it. You could also run it by your nurse manager and let administration look into it. This situation is way outside of your pay grade to get involved directly.

[NRSKarenRN, BSN, RN]

Putting on my PI Compliance Specialist hat, I understand your concerns. It may be that practitioner is yet to be credentialed at this hospital with unique password so physician has them sign in under their name with practitioner adding own name/credentials at end of note.

You have a couple of options:

1. Best: Discuss concern with practitioner at time of event

"Gee, (name) I went to chart on XYZ patient and saw DR So and So was logged in....I don't see him rounding.... oh he's not here please log him off." Practitioner's response will guide you in next step to see if one time occurrence or repeat behavior.

2. Observe practitioner computer entry next time on unit, if signed in under supervising physicians name, address using script #1.

This allows dialogue + possibly education re loggin

If not a minor issue, (await credentialing/ corrupted account) report to compliance hotline.

3. Call compliance hotline, report what you observed: patient medical record number, date + time practitioner entry. Let them investigate.

[icuRNmaggie, BSN, RN]

Is this a homework question for an ethics class?

[traumaRUs, MSN, APRN]

I'm an APRN and in one of the hospital systems I am credentialed at, we log in under our own name/password but we have an additional level where we then log in with the MD/DO that is going to co-sign the chart (required at this hospital). That way the MD/DO knows which charts/pts he has to see.

The MD/DO has two sets of log ins: one for when he sees a pt by himself and then another one where he can see which pts I've seen and that he needs to co-sign.

I am NOT logging in as the physician per se because my notes are attached to my name. However, when you look at the note quickly, it could appear that way.

If this is the case, I can assure you this is perfectly legal and acceptable. Why not just ask the NP?

[Corey Narry, MSN, RN, NP]

Let me just start by saying that sharing log-in passwords with any co-worker is illegal in our current EMR system under any circumstances where I work.

However, there are insurance billing regulations within Medicare and Medicaid that allows for an attending physician and an NP or PA to share a note for billing purposes. Both providers must have seen the patient in order to both write pertinent assessment data and evaluation and management on the chart. Could it be possible that this is what's going on here?

Also, in our setting, the rule is that any provider in the same specialty team can sign or write orders on the chart as long as the patient is under that care team. I could be writing and signing orders on a patient assigned to another provider as long as I am part of that ICU team of providers seeing that patient. I can also sign off on verbal orders entered by RN's that were given by any member of our provider team. Orders are not tied to billing.

[traumaRUs, MSN, APRN]

@Juan - I re-read my post and wanted to clarify that I'm not signing in as the MD/DO or sharing their log in.

We first sign in under our name/log in.

Then, we pend the note/orders to the assigned MD/DO by adding a second log in.

Both log ins are specific to each individual.

[OCNRN63, RN]

What kind of a rat hole do you work in? Guide wires left in when central lines are started, people fabricating vital signs, and this? You either have the worst luck in the world when it comes to picking jobs, or you're trying out your hand at a career writing nursing fiction.

[toomuchbaloney]

What kind of a rat hole do you work in? Guide wires left in when central lines are started, people fabricating vital signs, and this? You either have the worst luck in the world when it comes to picking jobs, or you're trying out your hand at a career writing nursing fiction.

This.

When I read this thread I wondered if the APN was visiting the patient for whom you falsified the record with fabricated VS.

[BuckyBadgerRN, ASN, RN]

I think you're misusing the word "illegal". It isn't "illegal" to share passwords/log in's/etc at your place of employment. Against regulation/policy/procedures, absolutely, but not at all illegal. Noone will be arrested, charged with a CRIME and risk being prosecuted for sharing a password. Not going to happen.

Let me just start by saying that sharing log-in passwords with any co-worker is illegal in our current EMR system under any circumstances where I work.

However, there are insurance billing regulations within Medicare and Medicaid that allows for an attending physician and an NP or PA to share a note for billing purposes. Both providers must have seen the patient in order to both write pertinent assessment data and evaluation and management on the chart. Could it be possible that this is what's going on here?

Also, in our setting, the rule is that any provider in the same specialty team can sign or write orders on the chart as long as the patient is under that care team. I could be writing and signing orders on a patient assigned to another provider as long as I am part of that ICU team of providers seeing that patient. I can also sign off on verbal orders entered by RN's that were given by any member of our provider team. Orders are not tied to billing.

[NRSKarenRN, BSN, RN]

They WILL be charged with a crime of fraudulent billing if signing in and documenting as physician instead of practitioner during Medicare/Insurance audit.