MD co-signing inpatient orders

Advanced Practice Columnist / Guide · Dec 31, 2015

I've not come across states that mandate a physician signature for orders written by NP's. It goes along with the prescriptive authority we are supposed to have in all the 50 states (albeit with various degrees of collaborative/supervisory requirement from physicians).

I've worked in the in-patient setting in many hospitals in 2 different states and not have any policy that my orders are signed by a physician (some places my notes have to be co-signed for shared billing). Check the language of your hospital by-laws and how your privileges are described.

The point of being credentialed by the institution you work for is that the medical staff have verified your qualifications to function as an independent licensed provider on your team.

Alicia777, MSN, NP · Dec 31, 2015

Thanks Juan. You know, I think a part of my confusion is that the majority of co-workers I have are PAs, which do require it. I will look into it..

TakeTwoAspirin, MSN, RN, APRN · Dec 31, 2015

Sounds like they are billing your services "incident to" a physician for the higher reimbursement rate.

Advanced Practice Columnist / Guide · Jan 1, 2016

Doubt that you're using "incident to billing" as that is not applicable in the in-patient setting. Besides, you are in a surgical specialty where billing is bundled under the surgical procedure. Also the act of writing orders in the hospital (much like writing a prescription in the clinic) is not a billable service. We don't get paid for the amount of orders we write.

I really think this is just misinformation on your physicians part as far as thinking that there is a requirement to co-sign your orders. Again, I would seek clarification with whoever is in charge at your institution. I personally would hate having to have physicians sign my orders as if they are verbal orders written by RN's. Our PA's also write orders independently, by the way.