Attestation statements
Priority Health will permit use of an attestation form when a signature is missing due to an inadvertent omission. The attestation is used to identify the provider of service and authenticate that medical record information is accurate and complete.
Inappropriate use of attestation
Although the attestation will be accepted regardless of the date it was created, it should not be utilized to "backdate" services relating to orders, plan of care, etc.
We require that a record be signed to be considered for medical review. Priority Health may report a provider for potential fraud if a provider is frequently/regularly using the attestation process rather than to correct the occasional inadvertently missing signature.
Attestation statement
In order to be considered valid for Priority Health documentation review purposes, an attestation statement must:
- Be signed and dated by the author of the medical record entry. Attestation statements will not be accepted if signed by someone other than the author of the medical record.
- Clearly identify the Priority Health member receiving treatment or services.
Priority Health suggests the following CMS-approved wording for an attestation:
"I, ___ [print full name of the physician/practitioner] __, hereby attest that the medical record entry for _____[date of service]___ accurately reflects signatures/notations that I made in my capacity as ___ [insert provider credentials, e.g., M.D.] __ when I treated/diagnosed the above listed Priority Health member. I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability."
Reference: CMS Medicare Program Integrity Manual, section 3.4.1.1.D.1.b (page 22 of this PDF document)
Additional requirements
The attestation statement should be submitted with:
- Priority Health Appeal form (Appeal I or II form depending on where provider is in process of appeals)
- Copy of medical records (if not already submitted)
- Explanation of why the signature was omitted from original medical record
Return to the Medical record signature requirements page
