The answer to your question has NOTHING to do with when the teaching physician signed the document.
It has EVERYTHING to do with
1) Who is the payer
2) When did the teaching physician actually see/examine the patient (if required).
Medicare and Medicaid require that the teaching physician be present at the bedside to provide supervision of the resident's services. The attestation statement ("Patient seen and examined with resident ...etc") needs to reflect the teaching physician's presence and participation in the care provided.
Most commercial payers will allow "supervision" by any means ... including a phone call. So the resident's statement "discussed with Dr Teacher who agreed with plan" is usually sufficient.
There are a lot of reasons why the date/time of signature will vary. Especially if the resident is dictating a note. For example: patient arrives through the ER at 10:30pm on Thursday. Resident (faculty present) sees patient immediately; dictates note at 11:30pm Thursday. Transcription doesn't get it typed until 07:30am Friday morning. Resident edits and signs first draft at 4:30 pm Friday afternoon. Teaching physician doesn't sign until Monday morning.
The fact that the dates/times of signature do not match does NOT affect whether this is a billable service.
What DOES affect the billability is whether the teaching physician has the correct attestation statement to signify his/her presence and participation in the care. "Agree with resident" might be sufficient for a commercial carrier, but will NOT fly with Medicare.
Hope that helps.
F Tessa Bartels, CPC, CEMC
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