If a provider's encounter notes should be co-signed by another user - for example, a supervising physician - their user profile can be set to allow or require them to request co-signature when signing a note.

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Any user can be set up as someone who must or may have their encounter notes co-signed by another provider, for example a supervising physician. Co-signature requirements are set up on a per-user basis under Admin > Manage > Users.

Who is eligible to be the cosigner? Any user with an NPI number in their user profile, who is not set as must "Always" require cosignature themselves can be set as the designated cosigner.

Co-signature options are generally based on what is selected for that user for "Does this user require a co-signature when signing encounter notes."

  • Never = co-signature options do not appear when that person signs an encounter note.
  • Can Request = co-signature options appear but co-signature is optional
  • Always = co-signature options appear and they must select a co-signer.

* Optional configuration note: co-signature can be optional in general for a user, but required for any of that user's notes that contain specific CPT codes and/ or specific prescriptions or alternate plan items in the Plan. This would be set up by special request to Cerbo.

A default cosigner for a user can also be set in their user profile under Admin > Manage > Users.

When a co-signature is requested, the note appears signed with a "Pending Co-Signature" label. The co-signature request appears in the designated cosigner's task list OR in the task list of every authorized cosigner if "Request Co-Signature From: Any Authorized Provider" is selected.

Cosigning a Note

Authorized cosigners in Cerbo are users who:

  • Have a Role of Provider or have an NPI on file and
  • Are not set to require co-signatures.

When someone cosigns a note, they can:

  1. Sign and leave the original signer as the provider of record for the encounter, with themselves as cosigner.
  2. Sign and take ownership, leaving the original signer as a cosigner.
  3. Sign and take ownership, removing the original signer from the encounter note signing record.

When the note is co-signed using options 1 or 2 above, it will show in the top right-hand corner both the signed date and user and the co-signed date and user. 

If option 3 is used, it would only show the cosigner as the note signer.

Co-signing cannot be undone. But if the note is unsigned, both the signature and co-signature will be cleared.

Once a not ie signed by the initial signer, the encounter summary (if applicable to the encounter type) will be visible on the patient portal 

Reporting on Charges in Cosigned Notes

End of day reporting in Cerbo shows charges or payments broken down by user. There are optional configuration settings that you can use to determine whether charge ownership is manually-assignable for the purposes of billing reports. However, by default, charges added inside a signed encounter note (and payments that are applied to those charges) are "owned" for billing reporting purposes by the primary note signer. That is the original note signer, unless the cosigner uses one of the options (2 or 3, above) that put the cosigner as the primary signer.

Other Keywords: supervisor, midlevel, nurse visit, approval, review, signoff, sign off