Q. I use an electronic medical record (EMR) in my practice, and I plan to participate in the Medicare EMR incentive program. I am considering hiring a scribe to enter information into the EMR during patient visits. Will Medicare allow this?
A. Yes, Medicare allows this, but you have to document the situation correctly to get paid.
A scribe is a nonclinical assistant who works one to one with a physician to document in the patient’s medical record the history, physical exam, and the diagnoses for each patient the physician sees. A scribe also can be a nonphysician practitioner (NPP) or a nurse. The physician or another health care professional must perform the medical service, while the scribe simply documents it.
For Medicare to cover a service for which you use a scribe, the documentation must clearly indicate:
- Who performed the service,
- Who recorded the service, and
- The qualifications (e.g., professional degree, medical title) of each.
Example: “Leslie Smith, RN, recording E&M service performed by Jay B. Jones, MD.”
Further, both the physician and scribe must sign the documentation.
When the Scribe Is an NPP
Let’s say Pat Brown, a licensed nurse practitioner (NP), accompanies Dr. Jay Jones during his hospital rounds. Both are at the patient’s bedside where Dr. Jones takes the history, performs the exam, makes medical decisions, and discusses the case with the patient. Nurse Brown documents the progress note and physician’s orders as dictated by Dr. Jones.
If Nurse Brown’s documentation demonstrates explicitly that Dr. Jones performed of any or all of the evaluation and management (E&M), Medicare will pay Dr. Jones for the service as either his personal service or an E&M service split-shared with Nurse Brown.
However, without clear description of Dr. Jones’ personal service (even if his signature is present), Medicare will pay for the service only if Nurse Brown reports it. Medicare will pay the NPP at the reduced rate of 85 percent of the full fee schedule amount.
Similarly, for an E&M service performed in the outpatient setting, with clear documentation of the physician’s personal service, Medicare will pay 100 percent of the fee schedule to Dr. Jones (under “incident to”/split-shared payment rules).
However, without explicit documentation of Dr. Jones’ personal service, Nurse Brown must report the service. If Dr. Jones did not personally perform any part of the E&M service but directly supervised the service of the Nurse Brown (and met all other “incident to” requirements), Medicare may consider paying Dr. Jones 100 percent of the fee schedule allowable under the “incident to” category.
You may use a scribe in any setting, but they are most commonly used in an inpatient hospital. TrailBlazer, the Texas Medicare carrier, expects the use of a scribe to be clinically appropriate for each situation and in accordance with all applicable state and federal laws governing the relevant professional practice, hospital bylaws, and any other applicable regulations.
Need Help Qualifying for Incentives?
If you need help achieving “meaningful use” to qualify for bonuses in the Medicare or Medicaid electronic health record incentive programs, turn to your regional extension (REC) center. Visit www.texmed.org/REC to learn more about RECs and the services they offer.
Published Dec. 13, 2010
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