Medicare Signature Guidelines

Medicare auditors, including your own Medicare Administrative Contractor (MAC), zone program integrity (ZPIC), supplemental medical review (SMRC), comprehensive error rating testing (CERT) contractors, and recovery audit contractors (RAC) review claims and associated chart documentation to detect improper payments. Signature requirements are part of these reviews.

CMS Transmittal 327, dated March 16, 2010, updated the Program Integrity Manual §3.4.1.1 for signature requirements. It states: “For medical review purposes, Medicare requires that services provided/ordered be authenticated by the persons responsible for the beneficiary in accordance with Medicare’s policies. … The method used shall be a handwritten or an electronic signature. Stamped signatures are not acceptable.”

All documents that are part of the medical record require a signature.  For example, office visits, consultation reports, interpretation of diagnostic tests, operative reports, and prescriptions require a signature.  This list is not exhaustive and we are not aware of any comprehensive official list.

This FAQ addresses the following:

1. Does Medicare look at provider signatures during a review?
2. What requirements exist for signatures?
3. What is an acceptable signature?
4. In the absence of an acceptable signature, are there other satisfactory alternatives?
5. What is a signature log?
6. What is an attestation statement and is it always valid?
7. Is a signature retroactive?
8. Do I need to confirm the signatures of ancillary staff in the medical record or signature log?
9. What if I use an electronic signature?
10. Which documents require a signature?

Also includes sample signature attestation statement.

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