Play the Medicare game, Keep your Money
Play the Medicare game, Keep your Money
Don’t play the Medicare game, lose Everything
Did you know that immediately after Medicare makes their quarterly or published policy changes, you will lose in appeal? 49% of the claims contested lost for just that reason. If caught you not only loose that money, you are red flagged, until you demonstrate compliance correction. For the O & P industry that amounted to Millions of dollars. Several practices that I personally know of went out of business.
Proper signature presentation plays an important role in this process.
Reducing Medicare’s discount.
Medicare and now other insurances have found the best way to reduce their cost is pay a claim only when legally necessary i.e. by not having to pay for a service they lower the cost commonly called a discount. They already had the tool to get that discount “improper paper work”.p
Now that that the first shock of round one (documentation) is over round two has started” validity of signature”. Primarily doctor and patient or guardian, and don’t be fooled when it comes to a signature we count too.
Insurances realize, if a signature will not stand up in a court of law it is not valid, and if one signature does not pass muster none of the documents for a particular claim count.
In the case of patient, and when necessary guardian, we must have every document designed in such a manner that it validates that the signature is for the document then the signature has the printed name with status and a date
You also need signed dated and printed patient and guardian name verification that they received all required unsigned documents Skip none.
In our case tie your name to the document (make sure the date is chronological with the rest of your documentation), and has a printed name with the signature and date.
The doctor’s signature must have authentation stating that particular scribble, electronic signature, or whatever (no stamps) refers to that particular individual with their credentials. Either in the document; or you must have on file a validation form.
Documents: Word documents are fine just protect all of the special wording, and structure. Be prepared to update on at least a quarterly basis. This easily can be a twelve round fight.
Competent Legal review of all documents you use is not a “too expensive” idea; it’s a “good” idea. Most facilities easily gross as much as they pay for their house and you don’t sell a house without having the paperwork checked.
Scan, store, and catalog all signed documents as a Pdf. Important use some sort of a cloud storage. Insurance can’t recover destroyed documents.
Below are a basic demonstration document to help you get an idea on design and a copy of the Medicare manual pages with signature requirements.
Example O&P Company, LLC
1234 Example Dr., Unknown, ST 12345-6789
John Doe C.P.
Progress Note DATE:__________________________________________
Patient:____________________________ DOB: __________________
Your signature___________________________________ date____________________
Your name typed________________
Manual and links.
5. Signature Requirements
CMS Manual System, Pub. 100-08, Medicare Program Integrity Manual, Chapter 3, §188.8.131.52
For medical review purposes, Medicare requires that services provided/ordered be authenticated by
the author. The method used shall be a handwritten or electronic signature. Stamped signatures are
The Medicare Program Integrity Manual notes several exceptions to normal signature requirements,
as listed below:
EXCEPTION 1: Facsimiles of original written or electronic signatures are acceptable for the
certifications of terminal illness for hospice.
EXCEPTION 2: There are some circumstances for which an order does not need to be signed. For
example, orders for some clinical diagnostic tests are not required to be signed. The rules in 42 CFR
410 and Pub.100-02 chapter 15, §80.6.1 state that if the order for the clinical diagnostic test is
unsigned, there must be medical documentation (e.g., a progress note) by the treating physician that
he/she intended the clinical diagnostic test be performed. This documentation showing the intent that
the test be performed must be authenticated by the author via a handwritten or electronic signature.
EXCEPTION 3: Other regulations and the CMS’ 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 listed in the Medicare Program Integrity Manual, Chapter 3 to discern the
identity and credentials (e.g., MD, RN, etc.) of the signator. In cases where the relevant regulation,
NCD, LCD and CMS manuals have specific signature requirements, those signature requirements
EXCEPTION 4: CMS would permit use of a rubber stamp for signature in accordance with the
Rehabilitation Act of 1973 in the case of an author with a physical disability that can provide proof to
a CMS contractor of his/her inability to sign their signature due to their disability. By affixing the
rubber stamp, the provider is certifying that they have reviewed the document.
Now let’s see some comments.