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Jan 29 2016

Those Pesky Signatures

Published by under Healthcare Reform

How many of us has received the dreaded notice that medical records are not complete; or worse, that records are complete but need to be signed. The absence of a “proper” signature gums up the works for getting paid.

This following is what CMS considers to be a valid signed order/record.

I won’t belabor the obvious.


If your signature is legible, you’re done.

If not, your illegible signature should be “connected” to something written or typewritten which is legible. Such as your legible printed name, letterhead, etc. If you are in a group and every doctor is listed in the letterhead, you’ll need to circle your name. Really. (Again, if your signature IS legible, you’re done and don’t need to worry about this.)

You have the alternative to submitting a signature log which gives meaning to your illegible signature.

Finally, something called an attestation will work. Here’s a sample attestation.

“I,  _____  [print full name of the physician/practitioner]  ___  , hereby attest that the medical record entry for _____  [date of service]  ___  accurately reflects signatures/notations that I made in my capacity as _____  [insert provider credentials, e.g., M.D.]  __when I treated/diagnosed the above listed Medicare beneficiary. I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.”

Guess what? An attestation has to be signed. Seems circular.

Alternatively, what about electronic signatures?

Yes, those are acceptable as long as it cannot be “tampered with” – and there’s an audit trail. EMRs typically address this just fine.

Interestingly, if you’ve ever sent a check to the IRS without your signature, legible or otherwise, the field office is instructed to submit for processing.

“Verify that an authorized signature appears on the check or money order. However, if the remittance is unsigned, and the taxpayer is not available to sign the check or money order, the unsigned check should be submitted for processing.”

Your bank may complete the transaction.

Out of our collective chicken scratches have sprung a litany of rules. Is this a self-inflicted wound? What do you think?

One response so far

Jan 22 2016

A Good Samaritan Saves the Day

Published by under Healthcare Reform

We’ve heard plenty of horror stories where someone tried to do the right thing – and got screwed.

Everyone knows the saying, “No Good Deed Goes Unpunished.”

Still, my faith in humanity was renewed on January 10th.

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12 responses so far

Jan 15 2016

What Can Happen When Patient Consent Is Fuzzy? A Bizarre Odyssey…

Published by under Healthcare Reform

Dr. Philip Taylor was employed by Spectrum Health Primary Care Partners. He practiced as an ob-gyn. His employment agreement with Spectrum defined how they could terminate the relationship.

Summary Termination. If your employment … is terminated by its Board of Directors [the “Board”] for a serious, intentional violation of the standards of patient care (i.e., serious quality and/or safety breaches), or unethical behavior, you will automatically be deemed to have voluntarily resigned or otherwise terminated your clinical privileges or medical staff membership at any Spectrum-owned hospital facility. Termination under these circumstances will be taken only after thorough investigation and review of facts by [the Board] which includes the President of [defendant] and CEO of Spectrum. Any termination described immediately above will be referred to in this Agreement as a “Summary Termination,” and will trigger automatic resignation of Medical Staff privileges. . . .

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4 responses so far

Jan 08 2016

Is Pimping Really Abusive?

Published by under Healthcare Reform

Yesterday, I read two articles in JAMA on pimping. (Yes, I still get JAMA.) The article suggested that pimping medical students and residents may be “old school.” Used inappropriately, it may serve more as a tool off abuse and humiliation as opposed to a pedagogical art.


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23 responses so far

Dec 31 2015

Easy New Year’s Resolutions for Cybersecurity.

Published by under Healthcare Reform

Some say there are two types of online sites. Those that know they have been hacked. And those that have been hacked, but don’t know it.


Everyone is busy. The important question is what can be done to mitigate the downside of sites being hacked.

You want two outcomes: (a) minimize the likelihood malicious hackers will empty all the cash in your accounts; (b) prevent malicious hackers from using nuggets of information to steal your identity and open new accounts in your name.

What to do.

First, don’t reuse passwords. Access by a hacker to one site should not make it easy to access every account you have on many sites. A unique password for each site should confine the damage to one site. Some use a password manager, which does simplify the process. But, that’s not mandatory. Just don’t have all your eggs in one basket.

Next, place a security freeze with all three large credit bureaus. This will make it difficult for a third party to open an account (credit card, bank, etc.) in your name. If you need to unfreeze your account to allow a known party to do a credit check, you can authorize that action for the briefest of times to get the job done. Then put the lock goes back on. Security freezes make sense for people who are not opening accounts or having credit checks done on a regular basis. This means it is useful for most people.

That’s it.

You can always do more. But, if your New Year’s Resolutions include the above tips, then you’re absolved from losing the ten pounds you’ve been promising to do every year.

One response so far

Dec 25 2015

Sometimes You Need a Good Laugh

Published by under Healthcare Reform

We often write about serious topics.


Not today.


I want to give a shout out to a site called Gomerblog.


GOMER is medical slang for a patient in the emergency room who is not in need of emergency services. For those of you not old enough to remember, it first appeared in widespread print in Samuel Shem’s book called House of God. GOMER is the acronym for Get Out of My Emergency Room. I learned this morning that gomere is a female gomer. Who knew?


Back to Gomerblog.


It bills itself as the Earth’s Finest Medical Satire and News. It’s certainly among the best. Here’s a sampling:


Uber Boston Announces New Services in Partnership with Ambulance Drivers.


Non-physician hospitals, The Web-MD and Wikipedia Clinic, to open in 5 major cities


Ophthalmologist Accidentally Agrees to See Inpatient Consult


Breaking News: Orthopedic Surgeon Completes 1000th Surgery with EBL of 50cc



2 responses so far

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