Medicare expects visit notes at the time of service
A short email, sent on the same day each week, tells each clinician how many notes wait for a signature and links to those notes, oldest first.
Co-founder, JotPsych
Some of your clinicians' notes are days old and unsigned, and you can't tell who is furthest behind. Pull two numbers for each clinician: the count of unsigned notes and the days the oldest has waited.
Subject: Your unsigned notes this week
You have x unsigned notes.
The oldest has waited x days.
Your unsigned notes, oldest first: link to your list in the EHR
Please sign the oldest note first.
One fix to try this week: a preset phrase for the visit type you leave open longest
Built on the email Chandani Narula, a practice administrator at Hartford Healthcare Medical Group, sends physicians each week about open charts. The linked list puts the oldest note first, so each clinician knows which note to sign first.
Medicare's manual covers timing and signatures.
If you bill Medicare, claim reviewers read your notes against the Medicare Program Integrity Manual, which expects each service documented in the medical record at the time it's rendered.
Your clinician's signature on a note affirms that the note documents the care. Your clinicians' notes drafted with AI need the same signature.
Chandani Narula, a practice administrator at Hartford Healthcare Medical Group, describes a physician who uses ambient AI to draft notes and still can't close charts on time.
"All services provided to beneficiaries are expected to be documented in the medical record at the time they are rendered."
"The treating physician/non-physician practitioner's (NPP's) signature on a note indicates that the physician/NPP affirms the note adequately documents the care provided."
"We note this type of practitioner concurrence is also required when using [AI] technology to capture the transcription of medical record entries."
Text from the Medicare Program Integrity Manual, chapter 3, read October 1, 2026. Count each AI draft that waits for your clinician's signature as an unsigned note.
Send the email on the same day each week.
Narula emails each physician with open charts every week. Open charts are visits whose notes aren't signed. The physicians "hate me when I send those weekly emails," Narula said. Expect pushback from your clinicians. Send your email anyway.
Link the list of unsigned notes, and name one fix.
Send each clinician a link to the list of unsigned notes in your EHR, sorted by visit date, oldest first. Your email then names no patient. Beside the count, name one fix you'll help with, such as a preset phrase for the visit type that stays open longest.
Write about the notes, not the person. Narula said of the numbers a practice tracks: "this is not going to be a scorecard to blame your teams."
JotPsych's All Clinic Notes, filtered to Reviewing and sorted Oldest First, lists unsigned notes with each note's author.
Book 15 minutes- Chandani Narula, practice administrator, Hartford Healthcare Medical Group, “Clicks to Capacity: A 90-Day EHR Optimization Playbook,” session A5, Medical Group Management Association (MGMA) 2026 Annual Conference, San Antonio, September 28, 2026.
- Centers for Medicare & Medicaid Services, Medicare Program Integrity Manual, chapter 3, sections 3.3.2.4 and 3.3.2.5, revisions 13008 (effective January 17, 2025) and 12633 (effective June 10, 2024), read October 1, 2026.