Medicare Signature Requirements
Medicare requires that services provided to a patient are authenticated in the patient health record.
-Hand written or electronic signatures are acceptable. -A handwritten signature is a mark or sign by an individual on a document to signify knowledge, approval, acceptance or obligation.
-Stamp signatures are not acceptable.
-You must be familiar with your Local Coverage Determination (LCD) policy on authenticating
records as these policies will take precedence over the guidelines below.
If your LCD does not have specific signature requirements regarding the legibility and presence of a signature, your contractor will following the guidelines below to determine the identity and credentials of the signatory.
Guidelines for Determining the Identity and Credentials of a Provider
-If, in the course of a patient health record review, a signature is found to be illegible, Medicare contractors will look for a signature log or attestation statement to determine the identity of the provider.
-A signature log includes a list of the typed or printed name(s) of the author(s) of the associated initials or illegible signature(s).
-The signature log can be included on the page where the initials or signature are present, or may be in a separate document.
-Although a reviewer may encourage providers to list their credentials in the signature log, a claim should be not denied if the log is missing a provider’s credentials.
- All signature logs should be considered regardless of the date the log was created.
Attesting to a Signature’s Validity
- Providers can include an attestation statement in the documentation they submit.
- Only the author of the medical record can attest to the record in question.
- Attestations will be accepted by reviewers regardless of the date of the attestation, except in those cases where the regulations or policy indicate that a signature must be in place prior to a given event or a given date. For example, if a policy states the physician must sign the plan of care before therapy begins, an attestation can be used to clarify the identity associated with an illegible signature but cannot be used to “backdate” the plan of care.
CMS recommends that, rather than backdating a patient health record, providers should use the signature authentication process explained below.
In some situations, a provider may be contacted by a contractor and asked to submit an
attestation statement or signature log. Providers will have 20 calendar days from the date of
the contractor’s call, or the date that the request letter is received by the post office, to provide the information.
To be valid for Medicare medical review purposes, the attestation statement must be signed and dated and contain sufficient information to identify the beneficiary. An example is included below:
“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.” --May 24, 2010
New Medicare Modifier -GX to be used as of April 1, 2010:
Information on the new -GX Modifier is listed in the following segment as well as a changed defnition to a common modifier used by Chiropractors. Details for the -GX modifier are as follows: Changes affecting the use of modifiers with Advance Beneficiary Notices (ABN) will become effective April 1, 2010. Specifically, 2 modifiers have been updated to distinguish between voluntary and required uses of liability notices.
Modifier -GA has been redefined to mean "Waiver of Liability Statement Issued as Required by Payer Policy" and should be used to report when required ABN was issued for a service.
Modifier -GX is a new modifier created with the definition "Notice of Liability Issued, Voluntary Under Payer Policy" and is to be used to report when a voluntary ABN was issued for a service.
Be aware of some details in the use of these modifiers.
-GA Modifier:
- Medicare systems will automatically deny lines submitted with the -GA modifier and covered charges on institutional claims;
- Medicare systems will assign beneficiary liability to claims automatically denied when the -GA modifier is present; and
- Medicare will use claim adjustment reason code 50 (These are non-covered services because this is not deemed a ‘medical necessity' by the payer.) when denying lines due to the presence of the -GA modifier.
-GX Modifier
- Medicare systems will recognize and allow the -GX modifier on claims, but will return your claim if the -GX modifier is used on any line reporting covered charges;
- Medicare systems will allow the -GX modifier to be reported on the same line as the following modifiers that indicator beneficiary liability: -GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit), -TS (Follow-up service);
- Medicare systems will return your claim if the -GX modifier is reported on the same line as any of the following liability-related modifiers: -EY (no doctor's order on file), -GA, -GL (medically unnecessary upgrade provided instead of non-upgraded item, no charge, no ABN), -GZ (item or service expected to be denied as not reasonable and necessary), -KB (Beneficiary requested upgrade for ABN, more than four modifiers identified on claim), -QL (Patient pronounced dead after ambulance is called), -TQ (basic life support transport by a volunteer ambulance provider);
- Medicare systems will automatically deny lines (using claim adjustment reason code 50) submitted with the -GX modifier and non-covered charges, and will assign beneficiary liability to claims automatically denied when the -GX modifier is present.
Medicare Updates:
The following information on Medicare fee schedule updates has recently been issued by the Centers for Medicare and Medicaid Services. I have paraphrased their statement to best describe to you the current status of Medicare fees:
As we learned in late 2009, Medicare elected to postpone the fee schedule update that was intended to be in effect January 1, 2010. At this time, it was stated that the 0% fee change would be in effect only until February, 28, 2010 and any fee changes would take place thereafter. However, Congress is still working to avoid the negative update that will take effect March 1, 2010. As a result of their efforts, CMS has instructed its contractors to hold claims containing services paid under the Medicare Physician Fee Schedules for the first 10 business days of March. The holding of these claims will only affect claims with dates of service March 1, 2010, and forward. Future updates will be posted as information becomes available. -Post Date: March 1, 2010
On March 2nd, the President signed into law a bill that delays the 21.2% Medicare fee cuts until March 31, 2010. Please stay tuned for future updates. -Post Date: March 4, 2010
On March 10, 2010, the Senate passed a bill that would delay the proposed Medicare fee cuts until September 30, 2010. As a result of this, the House and the Senate are evaluating their two bills to come to a mutual agreement. More data on this issue to be posted as it becomes available. -Post Date: March 23, 2010
The Medicare fee cut has yet again been delayed due to a delay in Congress evaluation of this issue. As a result of this, Medicare claims will be held again for 10 additional business days (Until April 14th, 2010). Stay tuned for future updates. -Post Date: March 31, 2010
On Thursday, April 15th, 2010, Congress passed legislation that will delay the scheduled 21% Medicare fee decrease until May 31, 2010. This delay provides Congress with additional time to develop a longer term solution to the proposed cuts. -Post Date: April 17, 2010