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Medical Coding News Archives

No Rubber Stamp on the Rubber Stamp Signature

July 3, 2013:

Regina Magnani, RHIT, Clinical/Technical Editor

Medicare will now accept rubber stamp signatures—but only from those with a physical disability hindering their ability to use a handwritten or electronic signature.

The rubber stamp exception to the provision requiring, for medical review purposes, a handwritten or electronic signature on authorizations for services provided or ordered was included in a May 17, 2013, transmittal for the Medicare Program Integrity Manual, Publication 100-8. The exception is in accordance with the Rehabilitation Act of 1973 and applies to someone with a physical disability who can provide proof to a CMS contractor of his/her inability to sign due to disability. By adding the rubber stamp signature, the provider is certifying that he/she has reviewed the document.

Chapter 3, section of Pub. 100-08 outlines the physician signature requirements for medical review purposes that apply to Medicare claim review by Medicare administrative contractors (MACs), the comprehensive error rate testing (CERT) contractor, and zone program integrity contractors (ZPICs). These contractors, along with recovery audit contractors (RACs), review claims and medical documentation providers submit to measure, detect, and correct improper payments in the fee-for-service (FFS) Medicare program.

For medical review purposes, Medicare requires that services provided or ordered be authenticated by the “author.” The three existing exceptions to the requirement that signatures be handwritten or electronic are outlined below:

  • Certifications of terminal illness for hospice. Facsimiles (faxes) of original written or electronic signatures are acceptable.
  • Those circumstances, such as orders for some clinical diagnostic tests, for which an order does not need to be signed, when there is medical documentation (e.g., a progress note) by the treating physician that he/she intended that the clinical diagnostic test be performed. The documentation showing the intent that the test be performed must be authenticated by the author via a handwritten or electronic signature.
  • Other regulations and the Centers for Medicare and Medicaid Services’ instructions regarding conditions of payment related to signatures (such as timeliness standards for particular benefits) take precedence. For medical review purposes, if the relevant regulation, NCD, LCD, and CMS manuals are silent on whether the signature needs to be legible or present and the signature is illegible/missing, the reviewer shall follow the guidelines in Pub. 100-08 to determine the identity and credentials (e.g., MD, RN, etc.) of the signer. When the relevant regulation, NCD, LCD, and CMS manuals have specific signature requirements, those requirements take precedence.

Stamped signatures are allowable only for physically disabled authors.

Note that these requirements may differ from the conditions of participation (COPs), which are not conditions of payment.


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