Debunking regulatory myths

Challenging misrepresentations

AMA’s regulatory myths series provides physicians and their care teams with resources to reduce guesswork and administrative burdens so the focus can be on streamlining clinical workflow processes, improving patient outcomes and increasing physician satisfaction.

The AMA provides regulatory clarification to physicians and their care teams in an effort to aid physicians in their day-to-day practice environment. 

Billing, coding and documentation

• Documenting time for each task during outpatient visits
  Are physicians required to document the time spent on each specific task associated with an outpatient visit?
• Double billing at federally qualified health centers (FQHCs)
  Can FQHCs bill for more than one visit on the same day per patient?
• Entering a diagnosis and procedure code
  Are only physicians and other billing health care professionals allowed to enter or change diagnosis and procedure codes?
• Impact of vital signs on level of service billed
  Does the number of vital signs recorded affect billing?
• Medicare coverage when patients leave hospital against medical advice
  Do Medicare and other payers deny payment for hospital services if a patient leaves against medical advice?
• Nonphysician entries in the patient record
  Are physicians required to redocument non-physician entries in the patient record?
• Preventive/wellness and evaluation and management (E/M) services
  Can physicians bill for both preventive and E/M services in the same visit?
• Use of note templates for documenting medical information
  Does CMS prohibit the use of note templates?

EHRs and interoperability

• Admission, discharge and transfer (ADT) messages
  Are hospitals required to deliver ADT notifications directly to a physician’s EHR inbox?
• “Break-the-Glass” EHR functionality
  Are “Break-the-Glass” functions required for employee EHR access?
• EHR gag clauses
  Can physicians openly discuss EHR issues?
• Responding to patient portal messages
  Can non-physician care team members respond to patient messages?
• Review of patient test results
  Must all test results be reviewed by patients’ primary care physician?
• Two-factor authentication for prescriptions
  Is two-factor authentication required for all prescriptions?

Joint Commission and other guidance

• Adherence to Joint Commission standards
  Are organizations only held accountable to Joint Commission standards?
• Mental health questions
  Are licensing/credentialing bodies required to probe into past mental health or substance use?

Patient care

• Advance care planning at Medicare visits
  Is advance care planning required at every Medicare patient visit?
• Chronic care management consent
  Is consent for chronic care management required regularly?
• Home health agency plan of care (POC) certification
  How should physicians sign home care plan of care recertifications?
• Online patient reviews
  Are physicians prohibited from responding to online patient reviews?
• Pain assessments
  Are clinicians required to ask patients about pain during every visit?
• Protected health information (PHI) disclosures
  Does HIPAA require that health care providers obtain patient authorization to disclose PHI for treatment purposes?
• Yearly visits for renewing non-controlled medication prescriptions
  Are yearly visits needed for renewing non-controlled medication prescriptions?

Scope of practice & roles

• EHR documentation
  Are EHR logouts required between clinical staff tasks?
• Computerized Provider Order Entry (CPOE)
  Is order entry a physician-only EHR task?
• EHR documentation
  Get real answers from the AMA to common myths about logging in and out of the EHR.
• Updating the problem list
  Is updating the problem list a physician-only task?

Other

• Food and drink contamination in work spaces
  Who determines where physicians and other health care workers can eat or drink while at work?

Earn CME

Interested in debunking a regulatory myth?