EM Coding Alert

Question: What are the specifics regarding provider signatures on claims? Is it ever safe for a physician to use a “stamp” signature?

Illinois Subscriber

Answer: When your physician or another provider performs a medical service for a Medicare patient, she must include either a handwritten or electronic signature in order to authenticate that fact. The “stamp” is only allowable in certain very specific situations.

A physician or another provider might be able to use a stamp in lieu of a written signature if the physician is physically not able to sign his name. You should maintain documentation describing the physician’s impairment is, and how that impairment affects his ability to sign documentation.

Examples: The physician broke his writing hand and it is in a full cast, he has Parkinson’s, his hands are paralyzed, etc.

Physicians that can sign off on their claims should do it every time. If you submit claims without a signature that passes muster with Medicare, you could be in for denials. If payers detect a consistent pattern of signature-deficient claims, you could be in for much worse penalties.

According to Medicare, a valid signature must:

• Authenticate services that the practitioner provided.
• Be handwritten or electronic — unless the author has a physical disability that prohibits her from providing a signature. In these cases, the provider can use a stamped signature if she “can provide proof to a CMS contractor of an inability to sign due to a disability,” CMS reports.
• Be legible.

According to Medicare, an electronic signature is valid as well, with some stipulations. Your practice’s software/computer system must have protections against electronic signature modifications; these standards should be stiff enough to correspond with any current signature laws on the books.

Remember: When you use an electronic signature, “the individual whose name is on the alternate signature method and the provider bear the responsibility for the authenticity of the information being attested to,” CMS warns.

CMS encourages providers to check with attorneys and malpractice insurers to be sure their electronic signatures meet all of the standards and regulations insurers have put forth.

Signature logs: In an effort to make the signature process more streamlined, Medicare does allow practices to keep a “signature log” on file for signing documents.

A signature log is a typed list of all of your practice’s healthcare providers, which includes their names and a corresponding signature. “A signature log may be used to establish signature identity as needed throughout the medical record documentation,” CMS states.