Good questions. It depends on the state, hospital bylaws, and CMG policy. Lack of independent practice rights in a particular state necessitates the need for physician supervision and makes the issue more simple. Ultimately, medicare and medicaid stipulate that for payment to be made for services rendered by an MLP, all regulatory guidelines must be met for that particular state. In states without independent practice authority, a physician must cosign the charts. Even in states allowing independent practice rights, you will still likely be expected to sign the medical charts. Again, you not only have medicare/medicaid state requirements to think about but also hospital policy and CMG policy. Between all of them, it would be the rare exception to find yourself in a job where you simply aren't required to sign APC charts in any capacity.
Now, the reason most CMGs want you to cosign the charts is multifactorial (see above) but ultimately it all comes down to billing. APCs can only bill for 85% of the physician fee schedule for medicare. If the physician is consulted, examines the patient or otherwise is involved in the medical decision making, then as long as an attestation qualifying that involvement is included in the chart, the service may be billed at 100% physician fee schedule. So....CMG is VERY interested in incentivizing you to put as many supervisory attestations as possible on the APC charts....so they can bill 100% We're talking about big breadcrumbs lost off the table when you neglect to add a supervisory attestation. What happens when you simply sign it without adding the attestation? It simply gets billed for 85%
Most CMGs will every so slightly pressure you to add a full supervisory statement without going so far as to require it. Why? Because, if you didn't actually see the pt and/or provide medical decision making, then adding a supervisory statement to that effect would be fraudulent billing. So as to minimize any chances of mass revolt from the physicians against APC supervision and subsequent increased malpractice risk, they closely align APC supervision with your compensation. What does this mean? At most shops, this means that the more charts you co-sign, the more you get paid. At my current gig, this can equate to almost $25/hr and more in some places. The clever part is that in many shops, if you add a supervisory attestation so that they can bill for 100% the physician fee schedule, you will see the increased billing compensation show up in your paycheck. This is a strong incentive for you to commit fraud and I've seen plenty of docs do it where they add a supervisory attestation and never saw them or talked to the APC about the pt. The CMG can't be blamed because they never actually required you to provide the attestation in your contract.
In short, most jobs will require you to, at the very least, sign the APC chart and provide supervisory management, especially if you are consulted on a patient in the ED. Most places will not force you to add supervisory attestations, though they will provide strong incentives for you to document them although this will increase your medicolegal risk exposure. I'm obviously not a lawyer, but my perception has always been that simply signing the note out of expected obligatory duties for your hospital/employer is much lower malpractice risk vis-a-vis adding a supervisory attestation....but it's not zero. I don't know if that answered all of your questions but hopefully sheds some light on the issue.
