“Timely” documentation

[gaspasser127]

Recently my practice has instituted a policy where clinic notes and procedure notes need to
Be completed within 24 hours.

they said it was a Medicare requirement

But… is it?

Can’t seem to find this online anywhere. They haven’t yet shown me any proof but to be fair i just asked them a few hours ago.

Have yall heard of anything like this?

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[paindoc007]

I get 24 for op notes as well, but I get 48 hours for office notes..

 

[BobBarker]

Not sure about that that. Seems far too brief. At my old hospital, some of the providers would be months behind. Like over 1000 encounters and orders behind. I guess the hospital wasn’t able to bill for most of their visits in hindsight. Maybe it didn’t matter with capitated Medicaid plans as this was mostly an issue in the pediatrics department.

 

[bedrock]

Recently my practice has instituted a policy where clinic notes and procedure notes need to
Be completed within 24 hours.

they said it was a Medicare requirement

But… is it?

Can’t seem to find this online anywhere. They haven’t yet shown me any proof but to be fair i just asked them a few hours ago.

Have yall heard of anything like this?

There is no Medicare rule like that.

I hate when bureaucrats invent rule out of thin air. I’d ask them for documentation of the source of this “rule”, ostensibly to ensure you’re fully in compliance….

 

[Malayil]

I think it’s six months for Medicare from my memory

 

[Ronin1]

They built it in to my metrics bonus for procedures 24 hours. 95% compliance or it cost me 5000

 

[Espn123]

There is definitely no Medicare rule. Our practice fines for over 1 week

 

[Centurion38]

After 30 days, reimbursement is difficult. After 90 days, it's basically impossible. But there is no hard and fast rule.

 

[lobelsteve]

They built it in to my metrics bonus for procedures 24 hours. 95% compliance or it cost me 5000

You mean you get $5000 extra for doing your notes on time.

 

[MitchLevi]

I do all my notes same day, only exception is if I somehow miss one and forget to do it (staff will send me a list of notes I didn't do).

IMO, doing a note 3 days later is more likely to be a fraudulent note. You may not remember details of the HPI, outside records, imaging, PE, etc.

 

[paindoc007]

I like that I have a deadline for a note. I too get fined if I don’t have timely chart completion. Forces me to do it and get it done promptly. My notes would turn from average to awful if I took weeks to complete, which I probably would without the financial penalty.

 

[paindoc007]

You mean you get $5000 extra for doing your notes on time.

No. Like me, we get a fine if I don’t hit target chart completion. We have a 8% income withholding each paycheck. If we hit our metrics, we get it back end of year. on time, OR start, chart, completion, monthly meeting, attendance, etc..

 

[DOctorJay]

99% of my notes are dictated in front of the patient and completed by the time I walk out of the exam room or procedure suite.

 

[MitchLevi]

99% of my notes are dictated in front of the patient and completed by the time I walk out of the exam room or procedure suite.

We're getting a new EMR next month. Can't wait. I'm on SRS (complete POS).

 

[paindoc007]

99% of my notes are dictated in front of the patient and completed by the time I walk out of the exam room or procedure suite.

Ahh, does this save a ton of time? I had one attending do this in training. He felt the best way to counsel and discuss was dictating in front of them so they hear. Maybe I should try that…

“ I emphaszed the importance of weight loss and therapy for his chronic back pain…” while staring at the patient and nodding. He felt he was killing two birds with one stone.

 

[DOctorJay]

Ahh, does this save a ton of time? I had one attending do this in training. He felt the best way to counsel and discuss was dictating in front of them so they hear. Maybe I should try that…

“ I emphaszed the importance of weight loss and therapy for his chronic back pain…” while staring at the patient and nodding. He felt he was killing two birds with one stone.

I think it saves some time and keeps me in the exam room longer with the patient so they feel like I spent more time. I tell them the plan, answer questions, then dictate and they hear the plan again. it also helps minimize errors in my note as the patient can let me know if there is an error right away. I didn't always do it this way as I was concerned patients would interrupt me but they don't as much as I had expected.

 

[SSdoc33]

We're getting a new EMR next month. Can't wait. I'm on SRS (complete POS).

careful what you wish for

whenever changing EMRs there are growing pains. i feel like i have had to learn how to do coding rather than medicine sometimes.

 

[MitchLevi]

careful what you wish for

whenever changing EMRs there are growing pains. i feel like i have had to learn how to do coding rather than medicine sometimes.

I hear you. Our current system is awful though. I'm expecting a few months of hardship.

 

[Ronin1]

You mean you get $5000 extra for doing your notes on time.

Lol sort of. I have a 25k metric bonus of which 20% is for timely documentation. Paid out yearly

 

[lobelsteve]

Lol sort of. I have a 25k metric bonus of which 20% is for timely documentation. Paid out yearly

A few years ago I had my bonus reduced in exchange for a higher salary.
It's about moving/hiding money to meet certain metrics.

 

[GlowInTheDark]

We're getting a new EMR next month. Can't wait. I'm on SRS (complete POS).

We have SRS. Total crap. Ortho docs and their 2 sentence notes don’t care. The history tracking and med management is nightmarish too. Just garbage.

 

[SeniorWrangler]

Just learned that the 48 hours were consecutive and not “business hours” as I’d been told, fun!

 

[bedrock]

We have SRS. Total crap. Ortho docs and their 2 sentence notes don’t care. The history tracking and med management is nightmarish too. Just garbage.

lol. A bunch of us are stuck with that.

Our orthos also use SRS, which is less than ideal. And we are also getting a new system this year.

Not only is SRS crap, it is expensive crap.

 

[sloh]

After 30 days, reimbursement is difficult. After 90 days, it's basically impossible. But there is no hard and fast rule.

Is this for Medicare or commercial insurers?

 

[MitchLevi]

SRS isn't an EMR. It's a medical record holding apparatus. You store medical records on SRS. That's it.

 

[wendalltwolf]

SRS isn't an EMR. It's a medical record holding apparatus. You store medical records on SRS. That's it.

Might as well use Google Docs then

 

[Ferrismonk]

Might as well use Google Docs then

But at least you can dictate from your phone.

 

[Ferrismonk]

I'm on the quality committee at my hospital. A few of our private insurances have quality metrics regarding timely notes. I think the hospital gets points (and thus money) if the notes are done within 5 days or something.

I've done SRS and dictating in the past. Glad that's over. Who tf wants to talk that much? Templates are where it's at.

 

[drrosenrosen]

I honestly have never understood not getting your notes done by the end of the day. Doesn't it bother you to have that hanging over your head when you go home? Like Mitch, the only time I do a note next day is if I forgot. I find that even if I wait several hours, the patients kind of blend together and it's harder to remember details of exam and history.

 

[Cholula]

If you billing base on time spent, all the time billed should be only the time spent on the date of service. Time spent on a different date doesn't count.
►Levels of E/M Services◄
Select the appropriate level of E/M services based on the following:
1. The level of the MDM as defined for each service, or
2. The total time for E/M services performed on the date of the encounter.

 

[Ronin1]

If you billing base on time spent, all the time billed should be only the time spent on the date of service. Time spent on a different date doesn't count.
►Levels of E/M Services◄
Select the appropriate level of E/M services based on the following:
1. The level of the MDM as defined for each service, or
2. The total time for E/M services performed on the date of the encounter.

Nobody on this forum bills by time. You would be broke

 

[Centurion38]

Is this for Medicare or commercial insurers?

CMS. But commercial insurers tend to follow their lead

 

[sloh]

CMS. But commercial insurers tend to follow their lead

Thanks for the response. That's interesting. I remember reading on the psychiatry forums a while back about psychiatrists completing their notes and submitting bills over a month later and still getting full reimbursement

 

[dozitgetchahi]

There is no Medicare rule like that.

I hate when bureaucrats invent rule out of thin air. I’d ask them for documentation of the source of this “rule”, ostensibly to ensure you’re fully in compliance….

Iirc, it is a CMS/Medicare “suggestion” that all documentation be completed within 72 hours…but not a requirement. I worked at a hospital previously that tried to tell us that all documentation absolutely had to be done by the end of the month, or else they weren’t allowed to bill it…but I looked into that and that is false too (although, as mentioned above, getting paid for the visit becomes harder after 30 days, and much harder after 90).

Obviously there are very good reasons to try to finish documentation as soon as possible. At my current PP, the policy is this: it’s “recommended” you finish the notes in 24 hours. If your notes are open after two weeks, there is a small fine for any notes open at that point.

 

[BobBarker]

My notes are always done same day. But I might not choose to lock them for quite awhile at the first of the year. 😉

 

[sloh]

My notes are always done same day. But I might not choose to lock them for quite awhile at the first of the year.

Those deductibles yoooooo

 

[RaceCanyon]

I honestly have never understood not getting your notes done by the end of the day. Doesn't it bother you to have that hanging over your head when you go home? Like Mitch, the only time I do a note next day is if I forgot. I find that even if I wait several hours, the patients kind of blend together and it's harder to remember details of exam and history.

I will often leave work early to get a run in or head to the gym when I see lighter days on the schedule in the future knowing that I can catch up with notes then. Work life balance is improtant for me

 

[pastafan]

CMS does not have a requirement but JCAHO does have requirements regarding procedure notes that we had to deal with in a hospital/ASC setting:

Operative and High Risk Procedure Reports - Timeframe of Dictation or Written | Ambulatory | Record of Care Treatment and Services RC

In what timeframe must an operative or other high-risk procedure report be dictated and placed in the medical record?

www.jointcommission.org