Legally Speaking

EMT Signatures

When you look at all the elements that go into documenting your PCR, requiring the crewmember’s signature seems very straight-forward. As our jobs become more paperless, the definition of a signature also changes. With the enormous emphasis on health care fraud, signatures have become an area of increasing scrutiny by Medicare and Medicaid—and not just for ambulance providers, but for physicians and hospitals, too.

Medicare implemented new signature rules during 2010 and we see the effects of this change when we submit medical records for an appeal or an audit. If the signature does not meet the standard, none of the medical record can be used and payment is denied. This has a major impact on our ability to collect payment.

Here is what the law requires--medical services provided must be “authenticated by the author”. This is fulfilled by a signature on the PCR. The signature can be either hand written or electronic. Medicare further defines what makes each signature type valid.

Handwritten Signatures

A hand written signature on a PCR must either be
* legible; or
* illegible with the name clearly printed below the signature; or
* illegible with a signature log attached

Here’s the way a signature log works. Your agency would keep an example of each EMT’s signature. If we need to send a PCR to Medicare and the signature is not legible, we would request a copy of the signature log from you and send it to Medicare with the PCR. A signature log might look like this:

Electronic Signatures

For the electronic signatures, just having the EMT name printed on the report is not enough. Medicare requires a short statement that clearly shows the person named is authenticating the report. “Authenticated by”, “Reviewed by”, “Verified by” or “Electronically signed by” would all satisfy this requirement. We suggest that you work with your IT or software support to have this added to your reports, if possible.

If we need to submit a PCR to Medicare that does not have a valid signature, we will send you a statement that attests to the validity of the report for the EMT to sign. Click Here to see the attestation statement.

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