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.
Specializes in ACNP-BC, Adult Critical Care, Cardiology.
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.
In the context of the medical record being a legal document and this discussion being about an APRN documenting a note, there will be legal repercussions including fraud which has happened. You may not think of it as a big deal as a bedside nurse but this is a Nurse Practitioner forum where our documentation is tied to billing/revenue.
First off, why do nurses feel compelled to come to the nurse practitioner forum to ask questions like this?
Let me ask you this: If you noticed a physician's nurse, or anyone for that matter, logging in as a physician and putting in orders, or documenting under that name, wouldn't you suspect this is wrong?
Every facility I have ever worked in has a policy that you learn about at orientation. You always have an anonymous hotline you can report this to. Call HR and ask them. They will know.
Now the real world. Some systems don't really facilitate the ARNP and MD to share a record on a patient. I worked at a facility where I had to write my note, and the MD would have to log in and add an addendum at the bottom. This created confusion for the PMD or hospitalist, because the note would be titled ARNP-Note. Not Cardiology consult, Cardiology follow up, etc. Then we would get accused of not seeing the patient.
I have seen some ARNP's work around this with the physician login.
Another example. At one facility, I could not see our list. It didn't matter how many IT guys called the "software guys", they couldn't make it work. One year went by, and I could not ever see the list. It was "tempting" to log in as the MD's to see the list. Can't work unless you know what to do.
But then, years ago I worked with a cardiologist who had a nurse. The nurse (maybe not even a nurse, for that matter), would see all of the patients in the morning. After office, about 3 pm, she would show up with the cardiologist and conveniently typed progress notes. She would stick the note in the chart, he would glance at it, sign it, and roll on down the hall.
That part is fine and dandy, but it is not ILLEGAL in the EMR, no matter how its spun
They WILL be charged with a crime of fraudulent billing if signing in and documenting as physician instead of practitioner during Medicare/Insurance audit.
Specializes in Education, FP, LNC, Forensics, ED, OB.
Hospitals create P/P that follow Local, State and Federal guidelines. Nurses must adhere to hospital P/P and if fraudulently using the legal medical record in any way, can and will be doing so illegally.
CMS, a federal "watchdog", uses measures to detect and try to reduce fraud in the Electronic Health Record (EHR).
Specializes in Palliative Care, Hospice, Home Health.
Are you sure they were definitely logged in under the physician's log in/password? In our system, whether I am the person that started a note/wrote the note, it shows up as being seen by the physician that I am working with. Only in the billing tab and if you scroll down to the end of the note would you ever know that I, the NP, saw the patient. My physicians need to co-sign my notes, which it will show both our names at the bottom of the note, but otherwise everything is in the physician's name.
Actually, it is illegal to document under someone else's login and bill medicare or any insurance company for the work.
CMS doesn't have any kind of "watchdog" measures to detect this. How would they? Install fingerprint scanners in the keyboards? Or maybe tiny little drones that fly around the hospital?
If a nurse practitioner is entering notes, and signing off as the physician, and that bill goes to medicare...that is fraud.
Simply using the login is only a violation of the hospital policy.
I know a physician who uses a scribe to dictate all of his work. She is a former med tech. She goes in the rooms, takes notes, dictates them under his name, and saves it as a draft. He adds a note "information above is collected and entered by J.Jones, certified mediacl scribe, based on my examination of the patient. I have reviewed the note, and find it to be accurate." (Or something like that). Then he signs it off.
Corey Narry, MSN, RN, NP
8 Articles; 4,475 Posts
In the context of the medical record being a legal document and this discussion being about an APRN documenting a note, there will be legal repercussions including fraud which has happened. You may not think of it as a big deal as a bedside nurse but this is a Nurse Practitioner forum where our documentation is tied to billing/revenue.