Last Modified: 12/27/2019
Location: FL, PR, USVI
Business: Part A, Part B
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.”
However, CMS neither requires nor instructs providers to use a specific form or format for the attestation statement.
Samples of signature attestation statements (English
) may be found on the First Coast website physician signature requirements simulation.
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