Physician (Supplier) Signature Requirement
The rules below apply to both assigned and unassigned claims unless otherwise indicated.
1. In a claim for services furnished by an individual physician (or supplier), the physician may:
a. In an unassigned claim, provide an itemized bill on his own letterhead - no physician signature required. A Form CMS-1500 on which the name or identification code of the physician has been stamped or preprinted in item 31 is the equivalent of the physician’s own letterhead.
b. Sign item 31 of Form CMS-1500.
c. Sign one time certification letter for machine-prepared claims submitted on other than paper vehicles.
d. Authorize an employee (e.g., nurse, secretary) to enter the physician’s signature in item 31 of the Form CMS-1500.
ii. By stamp-facsimile or block letters
iii. By computer
e. Authorize a nonemployee agent, e.g., billing service or association, to enter as in d. above, the physician’s signature in item 31 of the Form CMS-1500, followed by the agent’s name, title, and organization (e.g., a billing agent might enter by stamp “Dr. Tom Jones by Robert Smith, Secretary, Ajax Billing Service”). Alternatively, the agent may simply enter the physician’s signature.
2. In a claim by a clinic, hospital, or other entity authorized to bill and receive payment in its name for the services of the physician, the entity may:
a. In an unassigned claim, provide an itemized bill on its letterhead-no signature necessary. A Form CMS-1500 on which the name or identification code of the billing entity has been stamped or preprinted in item 8 is the equivalent of the reassignee’s own letterhead.
b. Have authorized official sign in item 25 of the Form CMS-1500 (item 13 of Form CMS-1554, item 6 of Form CMS-1556).
c. Have authorized official sign one-time certification letter for machine-prepared claims submitted on other than paper vehicles.
d. Have authorized employee, e.g., a secretary, enter authorized official’s signature in item 25 of the Form CMS-1500 (item 13 of Form CMS-1554, item 6 of Form CMS-1556) as in 1d.
e. Have nonemployee agent enter authorized official’s signature in item 25 of the Form CMS-1500 (item 13 of Form CMS-1554, item 6 of Form CMS-1556) as in 1.e.
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