Medicare Compliance & Reimbursement

But it doesn't apply to CMNs.

As home health agencies ring in the new year, they can also celebrate a change in signature requirements for physician orders. Starting Jan. 1, Medicare contractors "will accept stamped signatures when they are used by physicians on orders that are being reviewed for medical review purposes," says a bulletin newly posted to the Web sites of durable medical equipment regional carriers Cigna HealthCare and Palmetto GBA. "Contractors shall not deny claims on the basis of type of signature submitted," echo statements on the Web sites of regional home health intermediaries United Government Services and Cahaba GBA. Currently, only handwritten or electronic physician signatures are acceptable. The change in policy applies to all regions, Cigna Medical Director Robert Hoover Jr. tells MLR. "The change will expedite things and get orders returned faster from the doctor," predicts Sarah Lott, president of Texas Star Medical Billing in Vidor, TX. But DME suppliers must be careful to note that the new rule does NOT apply to certificates of medical necessity, the DMERC bulletin warns. "Note that there is no change in the prohibition of signature stamps in Section D of Certificates of Medical Necessity (CMNs)," it says. "As stated on CMN forms, 'Signature and date stamps are not acceptable'." And if state laws are stricter than this new rule, the state laws prevail, the notice adds. "If people don't pay close attention or are not properly educated, it could create problems," Lott cautions, especially if they don't realize the rule applies only to orders and not to CMNs. Providers and suppliers that want to speed the process of obtaining orders from physicians by using this more relaxed signature standard should educate physicians on the matter, Lott adds. But docs may be reluctant to use a stamp, due to security concerns. Many physicians "would say it is just easier to sign the order themselves," believes Nicole Thiroux with DMExpress Billing Service in Northridge, CA. "That stamp could cause a lot more chaos in the front or back office of a medical practice." Docs are more likely to have a medical assistant or nurse write up the prescription, then sign it themselves, Thiroux says. "As a doctor, I would be sure that use of the stamp was limited to only one or two very trustworthy employees," Lott points out. The DMERCs warn physicians of such problems in announcing the change. "Physicians must recognize that there is potential for misuse or abuse with a signature stamp or other alternate signature methods," the notice stresses. "Physicians should check with their attorneys and malpractice insurers in regard to the use of alternative signature methods."