Meeting Signature Requirements

Like many of the Medicare Administrative Contractors (MACs), National Government Services (NGS) report they have experienced an increasing number of Comprehensive Error Rate Testing (CERT) errors due to “signature requirements” not being met. Medical Providers are not signing orders or certification/recertification forms. All types of providers are failing to sign office visit notes.

Medicare requires that services provided/ordered/certified must be authenticated by the persons responsible for the care of the beneficiary in accordance with Medicare’s policies. Most, if not all, third-party payers follow Medicare’s signature guideline policy. The treating physician’s signature on a note indicates s/he affirms that the note adequately documents the care provided. Insurance reviewers are required to look for the signature (and date) of the treating provider on the note. The physician can use either a handwritten or electronic signature.

Acceptable Types of Signature How They Meet Requirements
Full Signature Signature is clear and legible
First Initial and Last Name Signature is clear and legible
Illegible Signature Placed over a typed or printed name
Illegible signature The letterhead, addressograph, or other information on the page indicates the identity of the signatory
Illegible signature not over a typed/printed name and not on letterhead Submitted documentation is accompanied by a signature log or an attestation
Initials Placed over a typed or printed name
Initials not over a typed/printed name Accompanied by a signature log or an attestation statement
Unsigned handwritten note Other entries on the same page in same handwriting are signed
    • Handwritten Signature: A handwritten signature is a mark or sign by an individual on a document signifying knowledge, approval, acceptance, or obligation.
    • Signature Log: Typed or printed name of the author associated with initials or illegible signature. It should include the provider’s credentials and be included as part of the medical record.
    • Signature Attestation Statement: Must be signed and dated by the author of the medical record entry and must contain sufficient information to identify the beneficiary for it to be considered valid for Medicare medical review purposes.
    • Electronic Signature: The author’s e-signature, full name, credentials, date, and time of e-signing.

Note: Stamped signatures are not acceptable.