The Centers for Medicare & Medicaid Services (CMS) requires that medical services provided or ordered be authenticated by the author’s handwritten or electronic signature. An electronic signature usually contains a date and timestamp, and a printed statement such as “electronically signed by” or “verified/reviewed by,” followed by the practitioner’s name and a professional designation. Stamped signatures are not acceptable, and neither are indications that a document has been, “signed but not read.”
CMS allows minor exceptions to the above rules, as outlined in CMS Pub 100-08 (Medicare Program Integrity), section 220.127.116.11 (Signature Requirements):
- “Facsimiles of original written or electronic signatures are acceptable for the certifications of terminal illness for hospice.”
- “Orders for some clinical diagnostic tests are not required to be signed…. if the order for the clinical diagnostic test is unsigned, there must be medical documentation (e.g., a progress note) by the treating physician that he/she intended the clinical diagnostic test be performed. This documentation showing the intent that the test be performed must be authenticated by the author via a handwritten or electronic signature.
- “CMS would permit use of a rubber stamp for signature in accordance with the Rehabilitation Act of 1973 in the case of an author with a physical disability that can provide proof to a CMS contractor of his/her inability to sign their signature due to their disability. By affixing the rubber stamp, the provider is certifying that they have reviewed the document.”
CMS instructs its payers to disregard orders without a proper signature. In other words, failure to sign the order may mean that the service may not be paid, and would be susceptible to audit findings and takebacks if the claim were paid.
Illegible signatures aren’t a deal breaker, but they require special attention. CMS instructs its payers to “consider evidence in a signature log, attestation statement, or other documentation submitted to determine the identity of the author of a medical record entry.”
A signature log will consist of the physician’s printed name, full signature, and initials that appear on the document. The physicians can also list his/her credentials for further proof and validation. A signature log might be included on the same page where the initials or illegible signature appear, or might be a separate document.
Providers should not add late signatures to the medical record beyond the short delay that occurs during the transcription process. Generally, 24-72 hours is the typical turnaround time for the provider transcription process. Instead providers may employ the signature authentication process.
Per CMS Pub 100-08, section 18.104.22.168, “Medicare does not accept retroactive orders. If the provider’s signature is missing from the medical record, submit an attestation statement from the author of the medical record.” Should a provider choose to submit an attestation statement, CMS recommends the following format:
I, _____[print full name of the physician/practitioner]___, hereby attest that the medical record entry for _____[date of service]___ accurately reflects signatures/notations that I made in my capacity as _____[insert provider credentials, e.g., M.D.]__when I treated/diagnosed the above listed Medicare beneficiary. I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.