Psychiatry Coding & Reimbursement Alert

Question: I’m having trouble getting my physicians to sign their claim forms. Some of them have even asked me if I can get them a signature stamp to save time. What should I tell these physicians?

Minnesota Subscriber

Answer: You should tell your physicians, in the gentlest terms possible, that when they provide a medical service for a patient, they must include either a handwritten or electronic signature in order to authenticate that fact.

Consequences: If you submit claims without a signature that passes muster with the payer, 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 or ordered.
• Be handwritten or electronic — unless the author has a physical disability that prohibits her from providing a handwritten or electronic 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.

E-signature caveat: According to CMS, an electronic signature is valid as well, with some stipulations. For instance, your practice’s software/computer system must have protections against electronic signature modifications, and 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.

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

Definition: 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.

For more information on Medicare’s signature requirements, see the fact sheet on “Complying with Medicare Signature Requirements,” which is online at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Signature_Requirements_Fact_Sheet_ICN905364.pdf.