Urology Coding Alert

Remember: You should only use stamped signature for special case.

In your urology practice, you must ensure that the provider signatures follow all of Medicare’s specific rules or you could face denials. Recently, Gail O’Leary and Lori Langevin, provider outreach and education consultants at National Government Services (NGS), taught the webinar “Medicare Signature Guidelines,” where they offered expert advice on how to determine that your physicians’ handwritten and electronic provider signatures meet all of the requirements of your Medicare administrative contractors (MACs).

Quiz yourself on the following questions.

See Why Signatures Important, When Required

Question 1: What are appropriate types of physician signatures to meet Medicare’s guidelines?

Answer: Medicare requires that all services provided or ordered be authenticated by the author of the medical record, O’Leary said. The appropriate method used for authenticating is either a handwritten or electronic signature.

Take a look at some examples of medical records requiring a signature, according to O’Leary:

• Dictated reports
• Outpatient visits
• Lab/diagnostic orders/requisitions
• Certificates of medical necessity
• Treatment plans/plan of care
• Treatment log notes
• Initial evaluations or current reevaluations
• Inpatient visits
• Office visits

Decipher How Medicare Defines Handwritten Signatures

Question 2: How does Medicare define a handwritten signature?

Answer: Medicare defines a handwritten signature as “a mark or sign by an individual on a document to signify knowledge, approval, acceptance, or obligation.”

Meet Electronic Signature Guidelines

Question 3: What are Medicare’s guidelines for electronic signatures?

Answer: Medicare has specific guidelines for electronic signatures. They are as follows:

• The systems and software your office uses must be protected against modification.
• Your administrative safeguards should follow standards and laws.
• Teach your office that whoever’s name is on the alternate signature method and the provider are taking responsibility that the attested info in the medical record is true.
• Include a copy of your office’s electronic signature protocol procedure.

Do This for Illegible Signatures

Question 4: What should I do if my provider’s signature is illegible?

Answer: In some cases, your provider’s signature may be illegible. If this happens, you can submit a signature log or an attestation statement, according to Langevin. Signature logs and attestation statements support the identity of the illegible signature.

You can automatically send the signature log/attestation statement along with your medical documentation to your MAC, Langevin added. Doing this will help avoid delays in the review process.

Understand Signature Log Definition

Question 5: What is a signature log?

Answer: A signature log is a typed listing of the provider or providers identifying their name with a corresponding handwritten signature, O’Leary said. The providers’ credentials are required, and the signature log must be part of the patient’s medical record.

Don’t miss: You may include the signature log on the same page where the initial or illegible signature is located or in a separate document, according to O’Leary. Just make sure that the signature log is a part of the patient’s medical record.

“A signature log can be created at any time,” Langevin added. “MACs will accept all submitted signature logs, regardless of the date they were created.”

Apply Attestation Statements in This Case

Question 6: When should I submit an attestation statement?

Answer: You can submit an attestation statement if your provider’s signature is illegible. For Medicare to consider an attestation statement valid, the author of the medical record entry must sign and date the statement, according to O’Leary. The statement must also include the appropriate patient information.

Caution: You can’t include a blank attestation statement with no patient identification information, O’Leary said. The statement must be personalized for each patient and signed by the physician.

Only Use Stamped Signature for This Instance

Question 7: Can we use a stamped physician signature under any circumstance?

Answer: Yes. Medicare will allow stamped signatures under a very special circumstance.

“Medicare will permit a rubber stamp for signatures in accordance with the Rehabilitation Act of 1973 in the case of an author with a physical disability,” Langevin said.