Last Modified: 7/6/2018
Location: FL, PR, USVI
Business: Part A, Part B
Signature attestation statement FAQ
Q: Where can I find an example of a "signature attestation statement"? Is a specific form required?
A. The Centers for Medicare & Medicaid Services (CMS) requires that any Medicare service provided or ordered must be authenticated by the author -- the one who provided or ordered that service. Certain types of signatures (e.g., illegible signatures, initials) may require the addition of a “signature attestation statement” or a signature log to the documentation to ensure the signature’s authentication. If documentation submitted for medical review does not contain a signature at all, then only a signature attestation will be accepted.
CMS issued change request (CR) 6698 
, which clarified Medicare fee-for-service signature requirements. According to CR 6698 , “In order to be considered valid for Medicare medical review purposes, an attestation statement must be signed and dated by the author of the medical record entry and must contain sufficient information to identify the beneficiary.”
, which clarified Medicare fee-for-service signature requirements. According to CR 6698 , “In order to be considered valid for Medicare medical review purposes, an attestation statement must be signed and dated by the author of the medical record entry and must contain sufficient information to identify the beneficiary.”However, CMS neither requires nor instructs providers to use a specific form or format for the attestation statement.
Note: Samples of signature attestation statements (English 
and Spanish ) may be found on the First Coast website physician signature requirements simulation.
and Spanish ) may be found on the First Coast website physician signature requirements simulation.
Please use your browser's back button to return to the referring page.First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
Help us make your experience better. Each new idea, self-service tool, or new article depends on you and your participation in our ForeSee customer satisfaction survey. Share your feedback, click here to take the survey now.
WHEN EXPERIENCE COUNTS & QUALITY MATTERS
All contents © 2018 First Coast Service Options Inc.
