Many Medicare Administrative Contractors, as well as federal and commercial audits, say that missing or illegible signatures are one of the top reasons for recoupment of payments.

The physician signature is required on all chart notes, orders and interpretations for testing services and operative reports. 

Paper charts:

• Have a signature log on file for anyone who documents in the chart, including the physician, technician and any other staff. This log should include their name and credentials, signature and initials.
• Update the log quarterly to account for staff turnover.
• If a signature is determined to be missing, the physician can provide an attestation statement. However, that statement may not be used for an order.
• Stamped signatures are not acceptable.

Electronic charts:

• The physician signature should include a statement indicating it is electronic, such as
• Electronically signed by
• Authenticated by
• A protocol should be in place to assure the signature is secure.
• Passwords should not be shared with staff.
• An example of EHR signature protocols can be found at aao.org/forms.

Be sure you are staying in compliance with signature protocols to avoid recoupment for services rendered.