Beneficiary Signature Requirements
- Medicare requires the signature of the beneficiary, or that of his or her representative, for both the purpose of accepting assignment and submitting a claim to Medicare. If the beneficiary is unable to sign because of a mental or physical condition, the following individuals may sign the claim on behalf of the beneficiary:
1. The beneficiary’s legal guardian
2. A relative or other person who receives social security or governmental benefits on behalf of the beneficiary
3. A relative or other person who arranges for the beneficiary’s treatment or exercises other responsibility for his or her affairs
4. A representative of an agency or institution that did not furnish the services for which payment is claimed but furnished other care, services or assistance to the beneficiary
5. A representative of the provider or of the nonparticipating hospital claiming payment for services it has furnished if the provider or nonparticipating hospital is unable to have the claim signed by any of the authorized individuals
6. A representative of the ambulance provider or supplier who is present during an emergency and/or nonemergency transport
7. The ambulance provider or supplier must maintain the following information and documentation in its records for at least seven years from the date of service:
* A contemporaneous statement, which is signed by an ambulance employee present during the trip to the receiving facility that at the time the service was provided, stating the beneficiary was physically or mentally incapable of signing the claim and that none of the individuals listed were available or willing to sign the claim on behalf of the beneficiary
* Documentation with the date and time the beneficiary was transported, and the name and location of the facility that received the beneficiary
* Either of the following:
o A signed contemporaneous statement from a representative of the facility that received the beneficiary which documents the name of the beneficiary and the date and time the beneficiary was received by the facility
o The required information from a representative of the facility using a secondary form of verification obtained at a later date, but prior to submitting the claim to Medicare for payment
o Secondary forms of verification include a copy of any of the following:
+ The signed patient care/trip report
+ The hospital registration/admissions sheet
+ The patient’s medical record
+ The hospital log
+ Other internal hospital records
A provider/supplier (or his employee) cannot request payment for services furnished except under circumstances fully documented to show that the beneficiary is unable to sign and that there is no other person to sign.
Medicare does not require that the signature to authorize claim submission be obtained at the time of transport for the purpose of accepting assignment of Medicare payment for ambulance benefits. When a provider/supplier is unable to obtain the signature of the beneficiary, or that of his or her representative, at the time of transport, may obtain this signature any time prior to submitting the claim to Medicare for payment.
If the beneficiary/representative refuses to authorize the submission of a claim, including a refusal to furnish an authorizing signatures, then the ambulance provider/supplier may not bill Medicare, but may bill the beneficiary (or his/her estate) for the full charge of the ambulance items and services furnished. If, after seeing the bill, the beneficiary/representative decides to have Medicare pay for these items and services, then a beneficiary/representative signature is required and the ambulance provider/supplier must afford the beneficiary/representative this option within the claims filing period.
last updated on 08/27/2010