Change Request (CR) 5971, issued March 28, 2008 with implementation date of April 28, 2008, clarifies CR5550, which was issued on August 24, 2007, with an effective and implementation date of September 3, 2007. The instructions for signature requirements have been clarified. Stamp signatures are not acceptable.
CR5971 indicates a change to the Centers for Medicare & Medicaid Services (CMS) Manual System, Publication 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.4.1.1 - Documentation Specifications for Areas Selected for Prepayment or Postpayment MR (Rev. 248; Issued: March 28, 2008; Effective Date: September 3, 2007; Implementation Date: April 28, 2008).
The following is the section of the manual that was revised. The changes are italicized and are in red.
B. Signature Requirements
Medicare requires a legible identifier for services provided/ordered. The method used shall be hand written or an electronic signature (stamp signatures are not acceptable) to sign an order or other medical record documentation for medical review purposes.
NOTED EXCEPTION: Facsimile of original written or electronic signatures are acceptable for the certifications of terminal illness for hospice.
Providers using electronic systems should recognize that there is a potential for misuse or abuse with alternate signature methods. Fascimile and hard copies of a physician's electronic signature must be in the patient's medical record for the certification of terminal illness for hospice. For example, providers need a system and software products which are protected against modification, etc., and should apply administrative procedures which are adequate and correspond to recognized standards and laws. The individual whose name is on the alternate signature method and the provider bears the responsibility for the authenticity of the information being attested to. Physicians should check with their attorneys and malpractice insurers in regard to the use of alternative signature methods.
All State licensure and State practice regulations continue to apply. Where State law is more restrictive than Medicare, the contractor needs to apply the State law standard. The signature requirements described here do not assure compliance with Medicare conditions of participation.
Note that this instruction does not supersede the prohibition for certificates of medical necessity (CMNs) and DME MAC information forms (DIFs). CMNs and DIFs are forms used to determine if the medical necessity and applicable coverage criteria for durable medical equipment, prosthetic, and orthotic supplies (DMEPOS) have been met.
How does this affect claims being reviewed by Medical Review?
For home health providers, effective with dates of service beginning April 28, 2008 stamp signatures will no longer be accepted as a valid physician's signature for home health orders, including the plan of care. Claims with physician stamp signatures will be denied during the medical review process.
For hospice providers, effective with dates of service beginning April 28, 2008, electronic signatures are now acceptable. Stamp signatures are not valid for certification of terminal illness.