Attestation Statements

For medical review purposes, Medicare requires that services provided and/or ordered be authenticated by the author. The method used shall be a hand-written or an electronic signature. Stamp signatures are not acceptable.

An attestation statement may be submitted to authenticate an illegible or missing signature on medical documentation. In order to be considered valid for Medicare Medical Review purposes, your attestation statement must be signed and dated by the author of the medical record entry and must include the following elements:

• Sufficient information to identify the beneficiary
• The printed full name of the physician/practitioner
• Date of service

Example
“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.”

While the above statement is an acceptable attestation format, at this time, Palmetto GBA neither requires nor instructs providers to use a certain form or format.

Notes

• You will not be contacted if the claim is or will be denied for reasons unrelated to the signature requirement
• If the signature is missing from an order, Palmetto GBA will disregard the order during the review of the claim and the submitter will not be contacted
• An attestation must be associated with a specific medical record
• Attestation statements may not be signed by someone other than the author of the medical record entry in question (even in cases where two individuals are in the same group, one should not sign for the other in medical record entries or attestation statements)
• Do not add late signatures to the medical record, (beyond the short delay that occurs during the transcription process) but instead should make use of the signature authentication process (listed above)

Resources

• Medicare Program Integrity Manual
• Signature Requirements (PDF, 110 KB) MLN Matters Article 6698
• Medical Records Signature Attestation Statement (PDF, 41 KB)