What Does a Virtual Medical Scribe Do During a Visit, and What Stays with the Clinician?
A virtual medical scribe joins the visit by audio or video link, records what the clinician does and says into the chart, and hands back a draft note. The clinician still examines the patient, makes every decision and reviews the note, because the clinician's signature is what Medicare looks for.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · 
In short: a virtual scribe drafts the note while the clinician treats the patient, and the clinician decides, reviews and signs. CMS does not require the scribe to sign, but it does treat the clinician's signature as affirming that the note documents the care.
What Happens Minute by Minute in a Scribed Visit?
The scribe works in the chart while the clinician works with the patient. The timeline below follows a made-up 20-minute established-patient visit in an internal medicine office.
| Time | What the scribe does | What the clinician does |
|---|---|---|
| Before the visit | Opens the chart, notes the reason for the visit, and lists the problems and medications already on file | Confirms the patient knows a scribe is present, following the practice's own consent policy |
| Minutes 1 to 5 | Records the history as the patient gives it, in the patient's words where possible | Asks the questions and decides which history matters |
| Minutes 6 to 12 | Records exam findings only as the clinician states them aloud | Performs the exam and says each finding |
| Minutes 13 to 18 | Records the assessment and plan as the clinician states them, including tests and prescriptions to be ordered | Decides the diagnoses and the plan, and enters or confirms orders |
| Minutes 19 to 20 | Flags anything unclear, such as a missing dose or side | Answers the flags |
| After the visit | Finishes the draft and routes it for review | Reads, corrects and signs |
Who Does What: Scribe, Clinician or Biller?
Medicare puts the clinical judgment on the clinician. The CMS evaluation and management booklet (MLN006764) says the treating physician or other qualified health care professional reporting the service determines the nature and extent of the history or physical examination, and that the care team may collect information that the reporting clinician reviews.
| Task | Scribe | Clinician | Billing staff |
|---|---|---|---|
| Recording history and exam findings | Writes what is said | States the findings and confirms them | Not involved |
| Diagnoses and plan | Writes what is said | Decides | Not involved |
| Orders and prescriptions | Notes them in the draft | Places or confirms them | Not involved |
| Choosing the visit level | Does not choose | Reports the service and supports it in the note | Checks the note supports the level before the claim goes out |
| Signing the note | Not required by CMS to sign | Signs | Looks for the signature before billing |
Orders are a practice choice, not a CMS rule. Many offices let only the clinician place an order, and a written policy settles who does what.
What Does Medicare Say About Signing a Scribed Note?
The CMS Program Integrity Manual, chapter 3, section 3.3.2.4, says that when a scribe is used to document medical record entries such as progress notes, CMS does not require the scribe to sign or date the documentation. The same note says the treating physician or non-physician practitioner's signature indicates that they affirm the note adequately documents the care provided.
So an unsigned or unreadable clinician signature is the weak point, not a missing scribe signature. The signature requirements rule covers what a valid signature, electronic signature and attestation look like, and the virtual medical scribe service page covers the documentation rules in more depth.
What Should the Clinician Check Before Signing a Scribed Note?
Read the whole note, not the summary. A 30-second check catches most of what a signature would otherwise vouch for.
- Is every exam finding one you actually made and said aloud?
- Does the history match what the patient told you, with no copied-forward text from an older visit?
- Are medications, doses and allergies right?
- Do the assessment and plan say what you decided, and is each order one you placed or confirmed?
- Does the note show the specific sign, symptom or complaint that made the service necessary? MLN006764 says that is required for every service billed.
- Is the note finished during the encounter or as soon as possible after? The same booklet says to document services during the encounter or as soon as possible after it.
Can a Scribe Pick the E/M Level or the Codes?
No, and the note should not be written to reach a level. MLN006764 says the medical record documentation must support the level of service reported to a payer, and that you do not use the volume of documentation to decide the specific level of service to bill.
A longer note is not a higher-level note. Billing staff or a coder reads the finished, signed note and picks the code from what it supports. If a note regularly reads thinner than the visit felt, take that back to the scribe as a template or training point.
Who Needs a Scribe, and What Needs to Be Signed with the Vendor?
Ask three questions before hiring one. Does the clinician finish notes after clinic hours? Are the visits mostly conversation, with several problems each? Is the practice's note template stable enough to teach? Yes to all three is the profile where a scribe is easiest to use.
A scribe from an outside company needs a business associate agreement. Under 45 CFR 160.103, a business associate creates, receives, maintains or transmits protected health information for a function or activity on behalf of a covered entity, other than as a member of its workforce. The HIPAA for billing vendors rule lists what the agreement has to contain, and the safety checklist for outsourcing covers access and audit controls.
How Nucleus Align Handles It
Our scribes are part of a team based across our offices in Vancouver, BC, Dubai, UAE and Islamabad, PAK, plus our registered office in Richmond, KY, and every client signs a Business Associate Agreement with us. Book a call to talk through which of your providers would use a scribe in internal medicine or another specialty, or read more on the blog.
- Medicare Program Integrity Manual, chapter 3, section 3.3.2.4 (Transmittal 12633) · CMS
- Evaluation and Management Services (MLN006764) · CMS MLN
- 45 CFR 160.103, Definitions · eCFR
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01What does a virtual medical scribe do?
A virtual medical scribe joins the visit remotely and records the history, exam findings, assessment and plan into the chart as the clinician states them. The scribe produces a draft. The clinician examines the patient, makes the decisions, reviews the draft and signs it.
02Does the scribe have to sign the note for Medicare?
No. The CMS Program Integrity Manual, chapter 3, section 3.3.2.4, says CMS does not require the scribe to sign or date the documentation. The treating physician or non-physician practitioner's signature indicates they affirm the note adequately documents the care provided.
03Can a scribe choose the visit level?
No. The clinician reports the service, and the signed note must support the level billed. CMS says not to use the volume of documentation to pick the level. Billing staff or a coder reads the finished note and assigns the code from what it supports.
04What should a clinician check before signing a scribed note?
Check that every exam finding is one you made, that the history is from this visit and not copied forward, that medications and allergies are right, and that the assessment and plan are yours. Confirm the note shows why the service was necessary.
Talk to a Billing Lead.
A 20-minute call about your payers, volume and setup. Monday to Friday, 9am to 5pm Eastern.