When it comes to collecting the documentation needed to bill Medicare for Emergency Medical Services (EMS), one of the most important tasks is to capture the patient signature on the patient care report. Without it, claims can be delayed or denied, and the patient may have to be billed directly. Yet this critical piece of the reimbursement puzzle too often is missing.

“Some departments and agencies do a great job getting the signature, but many do not,” said Mauricio Chavez, vice president of EMS operations for McKesson Business Performance Services (McKesson). “EMS personnel may forget or be too busy. There may not be a clear department policy. The patient may not be conscious or be in a position to sign.”

Whatever the reason, failure to collect a signature from either the patient or the patient’s representative can have a major impact on timely reimbursement, particularly for jurisdictions where the majority of patients transported are Medicare beneficiaries.

That’s why EMS personnel should always strive to obtain the signature at the time of transport, Chavez said. Because signatures are many times illegible, it’s also important to collect a printed name. A signature alone, in fact, is not compliant with Medicare requirements.

If the patient is unable to sign due to their condition, a signature from the patient’s representative can be acceptable. However, the signature must also be accompanied by a printed name, as well as a description of the representative’s relationship with the patient. A representative typically means a family member, but it could be nursing home staff or legal representative if a family member isn’t present.

If neither a family member nor provider is available to sign, EMS personnel can sign, as long as they provide a contemporaneous statement attesting to the fact that the patient could not sign and clearly document why this was the case. The crew should also request a signature from hospital personnel upon arrival at the emergency department.

Remember, whether it is a family member, legal representative or provider staff, the patient representative must also sign and print their name, as well as state their relationship to the patient. And the first responder must clearly document the specific reason why the patient was not able to sign.

At McKesson, an unsigned report triggers a Request for Information (RFI), which is mailed directly to the patient. The RFI asks for confirmation of insurance information in addition to a signature. Patients are given the option of logging onto McKesson’s www.peryourhealth.com site and completing an e-signature, which is valid for submission to Medicare. Should the patient fail to provide a signature either on paper or through the secure website, the patient is usually billed for the full amount of the service, but that is based on the local jurisdictions billing practice, Chavez said.

Avoiding self-pay accounts and the aggravation that can produce, including the potential for negative publicity, are important reasons for trying to get the signature up front.

“It may seem like a minor thing, but it can really take a toll financially if a lot of the patients you’re transporting are Medicare enrollees,” Chavez said. “That’s why we stress to customers that they should develop rigorous and consistent policies to make sure signatures are captured at the time of service, be it from a patient, family member or provider representative.”


About the author

McKesson Business Performance Services offers services and consulting to help hospitals, health systems, and physician practices improve business performance, boost margins and transition successfully to value-based care.