Question: May one practitioner authenticate a verbal order that was issued by another practitioner?  If so, can an Allied Health Professional (“AHP”) be among those who authenticate verbal orders issued by someone else?

Answer: One practitioner may authenticate the verbal orders of another practitioner as long as the authenticating practitioner “has knowledge of the patient’s hospital course, medical plan of care, condition, and current status.”  Also, the bylaws, policies and rules and regulations of the hospital must not prohibit one practitioner from authenticating the verbal order of another practitioner.

A final regulation addressing this topic was published by the Centers for Medicare & Medicaid Services (“CMS”) on May 16, 2012.  This final regulation states:

All orders, including verbal orders, must be dated, timed, and authenticated promptly by the ordering practitioner or by another practitioner who is responsible for the care of the patient only if such a practitioner is acting in accordance with State law, including scope-of-practice laws, hospital policies, and medical staff bylaws, rules, and regulations.

 42 C.F.R. §482.24(c)(2) (emphasis added).  Thus, CMS allows one practitioner to authenticate verbal orders of another practitioner if the authenticating practitioner:  (1) is “responsible for the care of the patient” and (2) acts in accordance with law and hospital policy.

CMS has provided additional guidance about these issues in the Interpretive Guidelines to the Medicare Conditions of Participation, including guidance on AHPs.  CMS states:

In some instances, the ordering practitioner may not be able to authenticate his or her verbal order (e.g., the ordering practitioner gives a verbal order which is written and transcribed, and then is – off duty for the weekend or an extended period of time).  In such cases…it is acceptable for another practitioner who is responsible for the patient’s care to authenticate the verbal order of the ordering practitioner….

• All practitioners responsible for the patient’s care are expected to have knowledge of the patient’s hospital course, medical plan of care, condition, and current status.

• When a practitioner other than the ordering practitioner signs a verbal order, that practitioner assumes responsibility for the order as being complete, accurate and final.

• A qualified licensed practitioner, such as a physician assistant (PA) or nurse practitioner (NP), may authenticate a physician’s or other qualified licensed practitioner’s verbal order only if the order is within his/her scope of practice and the patient is under his/her care.

Medicare State Operations Manual, Appendix A (emphasis added).

Also, both state law and the Medical Staff Rules and Regulations and policies of the hospital should be consulted to determine if they permit one practitioner to authenticate the verbal orders of another according to the conditions outlined above.

Please join us at the Advanced Practice Clinicians Workshop on May 1-2, 2014 in Atlanta to discuss additional issues related to the evolving role of non-physician practitioners.