Sign-In Please!
“Will the next mystery guest sign-in please?”
Back in the sixties there was this popular TV show that began with this question. The viewer got to see who the celebrity was based on the person’s signature and the contestants had to guess who the person was by asking questions about the person.
Signatures in EMS aren’t a game and there’s no mystery to the issue. Signatures in EMS are a big deal and becoming a bigger deal.
3 Areas of Focus
Today we’ll focus on three areas where signatures make a difference. The three topics we’ll cover are signatures as they relate to… The Patient Authorization, The Physicians Certification Statement and The Patient Care Report.
The Patient Authorization
With the uptick in fraud and abuse for several years, the need to obtain a signature shifted from assigning benefits to take on a whole new role as a verification that service was provided to the patient.
That’s a huge shift that gets lost to most of us.
So, obtaining the patient’s signature following EMS treatment and transport basically attests to the fact that you provided service to him/her. Don’t miss the significance of this shift. Your entire incident is really not valid without some form of allowable signature testifying to the fact that your incident really happened.
Of course, there is a lot more to obtaining a patient’s signature including…
- Verification of the presentation of a HIPAA Notice of Privacy Practices (NPP)
- Assignment of Benefits
- Permission to file appeals
- Permission and release of personal information
- Acceptance of financial responsibility (where directly applicable)
- Permission to bill on behalf of the patient to the responsible party- especially Medicare which carries a signature requirement for the provider of service
Do you see the overall importance?
As EMS providers our goal should be to obtain a signature, in the field, 100% of the time!
The Physicians Certification Statement
Also known as the PCS or PMNC or the “medical necessity form”, if you’re EMS agency is engaging in non-emergency, routine transports and billing Medicare for those services this form is a requirement.
The PCS must be executed by a healthcare professional outside of the EMS world in order to verify the medical necessity of the patient for ambulance transport and…THE FORM MUST BE SIGNED!
Who can sign?, where they sign?, how they sign?….that’s a separate blog (and we’ve written a few of those blogs- check the archives!) For the purposes of this post, we’ll make this blanket statement…someone has to sign the PCS! That signature either must be legible or identifiable.
It’s important that you know the rules about what trips require what signature, meaning the level of credentialing for the person signing off on the PCS. But it’s also important that you review how the person signed the form.
Many of us use interesting penmanship. If you can’t look at the signature and be able to know who signed, then it’s important that there is a printed name directly relational to the signature along with the person’s credentials (ie. RN, DO, MD, etc…)
Also, don’t forget that this signature MUST be dated. A date when the person signed near the actual signature is required.
The Patient Care Report
Last but certainly not least is the signature you add to the Patient Care Report (PCR).
The author of the PCR must sign the report. We also have begun to instruct our clients to make a reasonable attempt at having all members of the crew sign-off on the PCR for each incident.
Remember, an EMS provider applying a signature to a PCR verifies that the documentation of that incident actually happened as written. We are finding more and more payers, notably Railroad Medicare, that are rejecting certain actions such as appeals when a claim is denied if all members of the responding crew is not represented by a signature on the PCR.
These signatures can be electronic or an actual signed document, following the protocols permitted by your local, State or regional EMS credentialing bodies.
When signing, it is important to identify the person’s signature with a printed name complete with credentials (ie. EMT, EMT-P, etc…)
Listen up!
Don’t allow the signature issue to swing around and bite you. Of all the requirements we deal with, this one is easy. Remember the goal…100% signatures, 100% of the time!
