Wiki Time of signature & date required?

tdennis

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I have a situation where I am being told that if a physician does not indicate the "time" that he reviewed, signed, and dated a new patient questionaire, that the ROS covered on that questionaire cannot be counted due to Joint Commission requirements. I am not finding any evidence to support this and my feeling is that a new pt questionaire form is not a "time sensitive" document to begin with. Anyone have any advise or suggestions where I can find specific information regarding this?

Thanks,
td
 
I would ask them to supply you with the documentation that supports this requirement. I am not overly familiar with Joint Commision guidelines but I can't find anything that even comes close to that.

From an E/M audit stand point, in order to get credit for the ROS on a separate form the provider needs to mention the form by name and date completed. It doesn't even have to be completed for that visit, it could be a previous visits ROS form.

I would be interested to see any documentation that supports this type of requirement. I have never heard of anything that states they have to put down the time of day they reviewed a form. This is a bit extreme and will not go over well with my providers if it is in fact true.

Laura, CPC, CEMC
 
I am really not sure of the JC rules specifically about a ROS form....but I do think any health history form that the dr plans to refer to should be dated and signed the first time the patient fills it out, and the dr reviews it. Any updates to the form should be dated as well. This is a cover your you-know-what move.

As for the "time" requirement...JC does say that if your care facilty has any type of signature time limits in hours, such as "documentation must be authenticated/signed within 12 hours" than a time should be listed with the signature to ensure compliance...but this is not specific to ROS forms.
 
I do not think the Joint Commission rules apply in this case. The JC has the requirement for date, time and sign based on patient safety.

On our local Medicare website (WPS), it does state that any ROS forms referenced must include a date and location.
 
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