Home Health & Hospice Week

Stamped signatures no good for HHAs or hospices, CMS clarifies.

You may feel like the feds have been playing games with hospice signature rules, but now you have concrete instructions on what you can accept.

Red light: "Stamp signatures are not acceptable ... to sign an order or other medical record documentation," spells out a new transmittal the Centers for Medicare & Medicaid Services issued March 28.

That goes for physician signatures for home health agencies as well as hospices, CMS clarified at an Open Door Forum in January (see Eli's HCW, Vol. XVII, No. 3).

Green light: "Facsimile of original written or electronic signatures are acceptable for the certifications of terminal illness for hospice," CMS says in Transmittal No. 248 (CR 5971).

"Some hospices will be unhappy that they cannot accept stamped physician signatures," ex-pects Chicago-based regulatory consultant Rebecca Friedman Zuber.

But the pain should be minimized by the fact that CMS has allowed stamped signatures only a relatively short period of time. "Going back shouldn't be too difficult," Zuber predicts.

Most providers are just happy to get some concrete guidance on what they can do. "Clarifica-tion is a good thing," exclaims consultant Beth Carpenter with Beth Carpenter and Associates. "All hospices will appreciate the now-clear direction on what actually constitutes the legal identifiers for services provided/ordered."

Many hospices were taken unawares when CMS first announced its ban on stamped signatures based on an Aug. 24, 2007 memo. And CMS said in the January forum that faxed hospice certifications would be unacceptable.

CMS' approval of faxed signatures should make hospice staff's lives easier. Providers "are very glad they can use faxed signatures," notes Janet Neigh of the National Association for Home Care & Hospice.

Watch out: Use of electronic signatures, however, comes with some caveats. "Facsimile 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," CMS instructs in the transmittal.

Hospices using e-signatures also must safeguard against other kinds of "misuse or abuse" in electronic systems. "For example, providers need a system and software products which are protected against modification," CMS says.

And the provider is just as responsible for signature authenticity as the signer, an addition to the transmittal stresses.

This new provision may be a cause for concern, worries Burtsonville, MD-based health care attorney Elizabeth Hogue. "This language seems to put some of the burden of verifying signatures, etc. on hospices," Hogue tells Eli. "Hospices are likely to find attempts at verification to be daunting and potentially sensitive areas to address with physicians and their office staff members."

Despite the extra hoops hospices must jump through, the clarification will be helpful. Hospices will welcome the fact that they "can now officially use electronic physician signatures for certification of the terminal illness," Neigh observes.

Touch Base With Your Referral Sources

The new requirements don't take effect until April 28, which gives hospices some time to start educating their referral sources about the new rules, Neigh offers.

Start now: And the sooner the better, Hogue says. "The inability to accept stamped signatures may be contrary to the current practices of some physicians," she cautions. "Hospices should be proactive about educating them right away to avoid tension when orders with stamped signatures must be returned to physicians."

Educating referral sources should be easier now that "they will have something on paper to share," Zuber notes. 

You may want to take the chance to go over some other basics, too. "Clarification of this nature always presents an opportunity to educate physicians and their staff on the CMS requirements," Carpenter points out. 

Note: The transmittal is online at www.cms.hhs.gov/transmittals/downloads/R248PI.pdf.