Medicare has published revised rules regarding signature requirements that will impose additional documentation burdens on ambulance services if the patient or their representative is unable to sign.
Under the revised rule, an emergency (911) ambulance service would be permitted to submit a claim without the patient’s (or their representative’s) signature if:
-- The ambulance service documented that the patient was physically or mentally incapable of signing a claim at the time the service was provided;
-- There was no other person legally authorized to sign on the patient’s behalf at the time of service;
--The ambulance service obtained the following documentation (and kept it for four years from the date of service):
- A signed contemporaneous statement from an ambulance service employee present during the transport that documented that the patient was unable to sign and that no one was legally authorized to sign on the patient’s behalf
- The date and time the patient was transported, and the name and location of the facility where they were received
- A signed contemporaneous statement from a representative of the receiving facility, that documented the name of the beneficiary and the time they were received.
In lieu of a statement from the receiving facility, secondary forms of verification from the receiving facility could be obtained after the transport. Acceptable secondary forms include:
- Facility representative signing trip report
- Hospital admission sheet
- Patient’s medical record
- Hospital log or other hospital records
Review of trip report narratives reflect that a lot of these additional burdens could be immediately eliminated if field personnel in-service education would highlight the importance of patient or their representative’s signature gathering.
Without the required signatures or additional documentation requirements, claims cannot be submitted to Medicare for payment.