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welcome to this tutorial on signature requirements valid signatures and authentication the information given in this training is correct as of august 2020 the most current information related to this topic can be found on the meridian and cms websites at the links listed on this slide for medical review purposes medicare requires that services provided and ordered be authenticated by the author the method used shall be hand-written or electronic signature stamped signatures are not acceptable with one exception that i'll discuss in an upcoming slide the cms rules pertaining to signatures apply to all providers and suppliers of medicare services any medical record submitted to medicare for review must contain a valid signature in the case of review without proper signatures the documentation is considered invalid and cannot be used to support payment for services rendered and orders given there are four exceptions to the signature requirements when reviewing medical documentation exception 1 faxes of original written or electronic signatures are acceptable for certifications of terminal illness for hospice exception 2 there are some circumstances when an order does not need to be signed such as orders for some clinical diagnostic tests if the order for one of these tests is unsigned there must be medical documentation by the treating physician that he or she intended the test to be performed this documentation showing the intent must be authenticated by the author exception 3 for medical review purposes if the relevant regulations such as a national or local coverage determination is silent on whether the signature needs to be legible or present and the signature is illegible or missing the reviewer shall follow the signature guidelines in cases where the relevant regulation has specific signature requirements those signature requirements take precedence and exception 4 cms would permit use of a rubber stamp for signature in the case of an author with a physical disability that can provide proof to a cms contractor of his or her inability to sign their signature due to their disability the first acceptable signature is a handwritten one a hand-written signature is a mark or sign by an individual that signifies knowledge approval acceptance or obligation electronic signatures are another acceptable format and listed here are acceptable examples a full listing is provided in change request or cr 6698 the signature must also show the date and time reminders for submitting records to a review entity include ensuring the documentation has been signed by the provider submitting final copies and not preliminary or draft copies of documentation and indications that a document has been signed but not read are not acceptable with electronic signatures be sure the system and software products chosen are protected against modification and applies adequate administrative procedures that correspond to recognized standards and laws we encourage providers to check with attorneys and malpractice insurers concerning the use of alternative signature methods on an electronic signature record there is usually a statement such as authenticated by reviewed by or approved...