Beneficiary Signature Requirements

Section 424.36 of the Code of Federal Regulations requires a beneficiary signature authorization to be kept on file for all claims submitted to Medicare on the patient's behalf.  The purpose of the signature is to authorize the ambulance supplier to:

• Submit a claim to Medicare on the patient's behalf
• Release information
• Assign benefits/payments to the ambulance supplies
• Appeal a claim for denied benefits
• Acknowledgement of the receipt of the Notice of Privacy Practices under HIPAA regulations
• Verification that the ambulance services were provided

CMS commented in the Federal Register that the reason for enacting the new regulations were help ensure that services were in fact rendered and were rendered as billed.

The Federal Register, dated November 27, 2007, published the Final Rule regarding the new Patient Signature Regulations.  These regulations are effective for dates of service January 1, 2008 and forward; however, CMS will continue to accept comments until December 31, 2007.

Overview of the New Guidelines

Step 1 -            Ambulance Crew Members should attempt to obtain a patient signature authorization at the time of transport.  The patient's authorization signature should contain language of the above requirements.  A sample copy of a patient signature form is provided.

                        Exceptions:

·        If patient is deceased, no attempt to obtain a signature of family members or facility representatives is required.  Crew may check "yes" in the appropriate signature field, although a signature was not obtained.

·        If the patient is illiterate, physically handicapped or otherwise limited and unable to sign their full name, the patient can sign with an "X".  It is recommended that someone sign as a witness below the mark.

Step 2:             If the patient is physically or mentally incapable of signing, an authorized representative signature should be obtained.

                        The following is a list of individuals authorized to sign on the patient's behalf:

·        The beneficiary's legal guardian

·        A relative or other person who receives social security or other governmental benefits on the beneficiary's behalf. 

Otherwise Known as the Representative Payee

·        A relative or other person who arranges for the beneficiaries treatment or exercises other responsibility for his or her affairs

Such as a Power of Attorney, although the regulations do not require a legal POW to exist

·        A representative of an agency that did not furnish the services for which payment is claimed, but furnished other care, services, or assistance to the beneficiary

Such as a representative of the facility that scheduled the transport.  The regulations do not require the representative to have any special credentials or financial responsibility to the patient.

                        In the case of an authorized representative signature, the regulations state that the authorized representative should provide his/her relationship to the beneficiary and describe the reason in which the beneficiary is unable to sign.

Step 3:             This step applies to Emergency Services only:

                        The ambulance supplier may sign, IF:

·        The patient was physically or mentally incapable of signing; and

·        No authorized signer was available or willing to sign at the time of service

·        The supplier maintains three types of documentation on file for a 4 year period

The three types of documentation include:

·        A ?contemporaneous? statement from an employee of the ambulance service present during the transport that indicates that the patient was physically or mentally incapable of signing, and none of the authorized signers were available or willing to sign;

·        Documentation of the date and time the beneficiary was transported and the name and location of the facility that received the beneficiary; and

·        A signed ?contemporaneous? statement from a representative of the facility that received the beneficiary, which documents the name of the beneficiary and the date and time the beneficiary was received by that facility; or

·        Secondary Verification obtained a later date but prior to submitting the claim to Medicare in the form of:

o       A signed PCR (signed by a representative of the receiving facility)

o       The hospital registration/admission sheet

o       The patient?s medical record

o       The hospital log, or

o       Other internal hospital records

CMS has commented that the secondary verification must indicate that the beneficiary was transported to the facility by the ambulance supplier.