The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 6698 to clarify for providers how Medicare claims review contractors review claims and medical documentation submitted by providers. CR 6698 outlines the new rules for signatures. These revised/new signature guidelines are applicable for reviews conducted on or after the implementation date of April 16, 2010. Please note that all signature requirements in CR 6698 are effective retroactively for Comprehensive Error Rate Testing (CERT) for the November 2010 report period.
The previous language in the Program Integrity Manual (PIM) required a ‘legible identifier’ in the form of a handwritten or electronic signature for every service provided or ordered. CR 6698 updates these requirements and adds e- Prescribing language. See “Signature Guidelines for Medical Review Purposes” MLN article (CR 6698).
In situations where the guidelines indicate, reviewers will contact the person or organization that billed the claim and ask them if they would like to submit an attestation statement or signature log within 20 calendar days. The 20 day timeframe begins once the contractor makes an actual phone contact with the provider. If the biller submits an attestation or signature log, the reviewer shall consider the contents of the medical record entry.
- Biller/Provider will receive a system generated letter which will include the return address/fax. The following information should be included:
- Beneficiary name,
- HIC #,
- Claim Date of Service,
- Provider number/NPI,
- Name of the requestor/reviewer
In order to be considered valid for Medicare medical review purposes, an attestation statement:
- must be signed and dated by the author of the medical record entry and
- must contain sufficient information to identify the beneficiary.
Reviewers will NOT consider an attestation statement from someone other than the author of the medical entry in question.