Home Health & Hospice Week

Follow this expert advice to head off denials for missing or late physician signatures and the fraud scrutiny that may arise from them:

1. Start with education. Home health agencies can avoid physician signature mistakes by educating staff, offers consultant Pam Warmack with Clinic Connections in Ruston, La.

Don't presume that once you've covered a topic in a staff inservice that employees will retain the information, Warmack tells Eli. You should repeat training several times a year to reinforce information with existing staff and orient new staff.

2. Monitor your charts and claims. Before you send an end-of-episode claim out the door, you should conduct a pre-billing audit to check for numerous items including the physician's signature on the plan of care, Warmack advises.

It may be annoying, but you cannot bill for the episode until the physician signs the POC for it, stresses Chicago-based regulatory consultant Rebecca Friedman Zuber.

3. Work on securing doc signatures. Watching your cash flow get held up due to a physician who stalls or refuses to sign orders altogether is extremely frustrating, Zuber allows. But billing isn't an option until you obtain that signature.

Agencies in Illinois have tried a number of strategies to increase physician compliance, from faxing orders to working through hospital medical staff, Zuber notes. "We have even had agencies report physicians to the state licensing authority for refusing to sign orders," she says.

4. Cut them off. If you have a physician who habitually will not sign orders or signs them far too late, it may be time to say goodbye to her and her home care referrals.

"Agencies ... have had to refuse referrals from certain doctors because their non-compliance has just cost the agencies too much money in services provided for which they cannot file claims," Zuber relates.

5. Follow signature rules. Stamped signatures will not pass muster in medical review, the Centers for Medicare & Medicaid Services says in Transmittal No. 327 (CR 6698). Don't accept them.

Also, if you receive an undated signature, make sure to indicate in the record when you received it, CMS says. Finally, if a signature is illegible, you may use a signature log or attestation statement to verify it -- even if those are created after the fact.