CMS Final Rule Regarding Ambulance Signature Requirements

In November 2008, Medicare released the Final Rule that contains more changes to the beneficiary signature requirements contained in 42 CFR §424.36. The rule becomes effective on January 1, 2009.
Summary of the Final Rule
PWW's summary of the changes of the final rule are as follows: 

·        CMS did not adopt the proposed language at 42 CFR §424.36(a) that would have required ambulance services to first make “reasonable efforts to obtain the signature of the beneficiary” before relying on the signature of one of the authorized signers (such as a legal guardian or POA).  There was a lot of confusion over what “reasonable efforts” meant and since CMS has decided not to adopt the new language, ambulance services can continue the previous practice of obtaining the signature of an authorized signor under §424.36(b) when the beneficiary is incapable of signing.  Obtaining the signature of an authorized signor will allow an ambulance service to satisfy the signature requirement and subsequently enable the service to submit the claim for reimbursement, provided all other requirements for medical necessity are met. 

·        CMS added language to the regulation to clarify that a patient signature does not have to appear on the actual claim submitted to Medicare for reimbursement.  The Final Rule states that for purposes of the signature rule, the term “claim” can mean the claim form itself or a form that contains adequate notice that the purpose of the signature is to authorize a provider or supplier to submit a claim to Medicare for services. This is essentially a clarification of current practice since patients and authorized signers rarely sign the actual “claim forms” anyway.  

·        CMS added the term “non-emergency” to the exception at §424.36(b)(6). Now, in both emergency and non-emergency situations, if an ambulance service is unable to obtain the signature of the beneficiary or an authorized signor at the time of transport, the service may sign on behalf of the beneficiary, provided it fulfills the “contemporaneous signature” or “other forms of documentation” requirements as listed in the (b)(6) exception.

·        CMS added language to (b)(6) to allow documentation from a “facility” as acceptable secondary forms of verification under the (b)(6) exception.  In light of the expansion of the exception to non-emergency transports, ambulance services may now obtain registration or admission sheets and logs from other facilities when the receiving facility is not a hospital.

·        CMS also affirmed that only ­­providers­, ­and not suppliers, may sign on behalf of the patient under §424.36(b)(5). 

To view the excerpted Signature Rule regulations, CLICK HERE (PDF format).   To view the Federal Register Final Rule, CLICK HERE (PDF Format).
SAMPLE SIGNATURE FORMS AVAILABLE - Click Here to access PWW's Free Forms Library!