When patients attend an appointment at their primary care provider's office, he or she may not see an actual physician. This can be true in any number of specialties, where physician services are provided, even though an actual, licensed physician is not the person with whom the patient interacts.
Licensed physicians utilize a number of personnel who are known as care extenders. This allows for a medical practice to evaluate and treat many more patients in a day than a single doctor could do on his or her own. There are only so many working hours in a day, and by employing trained professionals to assist in seeing and treating patient's conditions, a licensed physician does not abdicate his or her responsibility. Rather, he or she oversees all the care being performed in his or her name.
It is a legal requirement that a doctor reviews charts for all Medicaid patients who are evaluated and treated by physician's assistants or by nurse practitioners. After he patient encounter, the licensed physician will review the patient's chart to ensure that the history and physical exam conducted are extensive enough for the patient's presenting condition. Without active doctor oversight, professional services are not legally considered to have been performed, and, thus, no billing can be generated to Medicaid for reimbursement. These guidelines vary somewhat by state, especially in the case of nurse practitioners.
Physician's assistants are not legally sanctioned to initiate new care protocols without the prior approval of the licensed physician they are assisting. In addition, the doctor should conduct a brief interview with the patient to confirm the assistant's findings, and to confirm the prescribed care of plan is appropriate. After a thorough record review, and co-signature by the licensed physician, care can then begin.
In the case of nurse practitioners, who have a higher level of professional training than a physician's assistant, evaluation and management can be initiated at the nurse practitioner level without direct approval from a licensed physician. This does not mean that a doctor is unaware of what has been prescribed for the patients under his or her care. A doctor reviews charts for all patients who are under his or her care. When the standards of care have been adhered to, the doctor then signs the chart to signify his or agreement with what occurred during a patient encounter.
Medicaid requirements vary by state, so it is important to verify beforehand what the requirements are in any given jurisdiction when receiving care from licensed physicians, physician's assistants, or from nurse
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