ED Coding and Reimbursement Alert

Question: One of our physicians likes to sign everything with just his initials, or sometimes an illegible scrawl. Do we need some type of documentation to support what an auditor might not be able to read?

Alaska Subscriber

Answer: Yes, you should council your provider that this type of signature may not be allowed under audit. Additionally, you would be wise to keep a signature log as additional documentation.

What it is: If the chart includes an illegible signature or solely the provider's initials instead of a full signature, you could be denied under audit and might need to include a signature log along with the documentation for the payer. The log identifies the provider associated with the service. You can include the log on the page with the initials or illegible signature or as a separate document. "Reviewers will consider all submitted signature logs regardless of the date they were created," states MLM Matters bulletin MM6698, implemented April 16, 2010.

Medicare requires that the professional who orders or provides services authenticate the services. The documentation must contain either "a legible handwritten, full signature with credentials, handwritten initials over a typed or printed name, or electronic signature," according to information from National Government Services (NGS). Otherwise, the payer could deny your claim. Medicare defines a handwritten signature as "a mark or sign by an individual on a document to signify knowledge, approval, acceptance, or obligation," according to bulletin MM6698. q

-- Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.