Medicare reimbursement requires a legible provider identity for services rendered or ordered. When you submit an order or other medical record documentation for Medicare to review for coverage, you can use a handwritten or electronic signature. The Centers for Medicare & Medicaid Services (CMS) says it will not accept medical records containing a physician's stamped signature . CMS auditors will reject any document signed with a physician's signature stamp.
What Is an Electronic Signature?
There are several definitions to clarify.
- A digitized signature is an image of a pen-to-paper signature.
- An electronic signature can be an electronic sound, symbol, or process associated with a record. It is a mark added to a document to indicate intent to sign.
- A digital signature is a form of encryption that tightly binds documents to a unique number or electronic "fingerprint." Private companies called certification authorities provide private/public software key combinations used to encrypt and decrypt documents, and they issue "certificates" to bind the public keys to the key holders. However, certification business practice lacks national governance guidelines.
Electronic signatures are legally valid in all 50 states, and the security standards of electronic signatures are addressed in the security and privacy provision of the Health Insurance Portability and Accountability Act (HIPAA).
HIPAA transactions do not require a digital signature at this time. However, HIPAA-covered entities that use electronic signatures for transactions must adhere to U.S. Department of Health and Human Services electronic signature standards. The software program must provide:
- Nonrepudiation - assurance that the signer cannot deny signing the document in the future,
- User authentication - verification of the signer's identity at the time the signature was generated, and
- Message integrity - certainty that the document has not been altered since it was signed.
Check with your electronic medical record (EMR), practice management system, or e-prescribing vendor to verify the program's ability to use electronic signatures. Most current EMR applications use some form of electronic signature to append the provider's name, marking the encounter as closed.
ePrescribing and the Electronic Signature
A 2000 law effectively voids previous requirements that prescriptions be on paper or printed as a hard copy and does away with requirements that prescriptions be hand signed. The practitioner can sign written prescriptions electronically using a system that replicates the practitioner's manual signature, provided that (1) the system's security features require the practitioner to authorize each use and (2) the prescription is printed on paper designed to prevent unauthorized copying of a completed prescription, or erasure or modification of information written on the prescription.
Note, however, that while regulations permit electronic signatures, nothing currently requires a pharmacist to honor the prescription; the dispensing of a drug is conditioned on the pharmacist's sound professional judgment. For more information, read the Texas Administrative Code .
TMA's Department of Health Information Technology is dedicated to helping physicians experience the quality and efficiency benefits of the successful implementation of office technologies through education, resources, and consultations. For more information, contact TMA at (800) 880-5720 or e-mail HIT .
To discuss the electronic signatures and e-prescribing with your peers, visit the TMA Office Technologies Online Community at www.tmacommunities.org .
Meinhardt. (2000). New "E-Sign" Law Enables Electronic Prescriptions. Drug Benefit Trends 12(9):23-24.
Wang et al. (2001). Digital Signature Technology for Health Care Applications. South Med J 94(3):281-286.
Zuckerman, A. (2001). Restructuring the Electronic Medical Record to Incorporate Full Digital Signature Capability. American Medical Informatics Association. 791-795.
Content reviewed: 2/26/09