MLN Matters Number: MM5971                                            Related Change Request (CR) #: 5971
Related CR Release Date: March 28, 2008                               Effective Date: September 3, 2007
Related CR Transmittal #: R248PI                                            Implementation Date: April 28, 2008

CR 5550 Clarification - Signature Requirements

Provider Types Affected
Physicians and other providers who bill Medicare Contractors (carriers, fiscal intermediaries, regional home health intermediaries, Part A/B Medicare Administrative Contractors, including Durable Medical Equipment Medicare Administrative Contractors) for care provided to Medicare beneficiaries in hospice

What You Need to Know
CR 5971, from which this article is taken, clarifies the instructions on signature requirements for the certification of terminal illness for hospice. It provides that Medicare contractors will accept a facsimile of an original written or electronic signature in documenting the certification of terminal illness for hospice.

Make sure that your billing staffs are aware that, to document the certification of terminal illness for hospice, a facsimile of an original written or electronic signature is acceptable.

CR 5971, from which this article is taken, clarifies the instructions in Medicare Program Integrity Manual Chapter 3 (Verifying Potential Errors and Taking Corrective Actions), Subsection 3.4.1.1B (Signature Requirements) that address the signature requirements for the certification of terminal illness for hospice, that were provided in CR 5550 (Various Medical Review Clarifications).

Subsection 3.4.1.1B of the manual notes that Medicare contractors require a legible identifier for services provided/ordered. It further requires that when this documentation is for medical review purposes, the only acceptable method of documenting the provider signature is by written or an electronic signature. Stamp signatures are not acceptable to sign an order or other medical record documentation for medical review purposes.

CR 5971 provides that there is an exception to this requirement.

It announces that a facsimile of an original written or electronic signature is acceptable for the certification of terminal illness for hospice. Please be sure to note however, that while a signature facsimile is acceptable in this instance; it and hard copies of a physician’s electronic signature must be present in the patient’s medical record.

Additional Information
You can find more information about the signature requirements for the certification of terminal illness for hospice by going to CR 5971, located at http://www.cms.hhs.gov/Transmittals/downloads/R248PI.pdf on the CMS Web site. You will find updated Medicare Program Integrity Manual Chapter 3 (Verifying Potential Errors and Taking Corrective Actions), Subsection 3.4.1.1B (Signature Requirements) as an attachment to this CR.

If you have any questions, please contact your Medicare contractor at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2007 American Medical Association.

News Flash – The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that a new educational resource, the 2008 PQRI Fact Sheet, has been posted to the Physician’s Quality Reporting Initiative (PQRI) Web page on the CMS Web site. This Fact Sheet provides an overview of the 2008 Physician Quality Reporting Initiative. To access this new and all available PQRI educational resources, visit http://www.cms.hhs.gov/PQRI on the CMS Web site and click on the Educational Resources tab. Once on the Educational Resources page, scroll down to the “Downloads” section and click on the “2008 PQRI Fact Sheet” link.

Posted: 04/18/2008