Patient Signature Requirements for Ambulance Claims

The CMS IOM Publication 100-02, Chapter 10, Section 20.1.2, explains the patient signature requirements. It indicates to use the signature to accept assignment and allow for claims filing.

A beneficiary is always able to sign on his/her own behalf. If he/she is unable to sign, the following can sign on his/her behalf:

• Beneficiary's legal guardian

• A relative or other person

  • Receiving Social Security or other governmental benefits on his/her behalf

  • Arranging the beneficiary’s treatment or exercising responsibilities for his/her affairs

• An agency representative from an institution not furnishing the services on the claim

  • Furnishing other care, services, or assistance to the beneficiary

• A supplier is unable to have the claim signed in accordance with 42 CFR 424.36(b) (1-4) (C)

• A representative of the ambulance supplier

  • Present during an emergency and/or nonemergency transport

After transport, an ambulance supplier may obtain a signature. Always have a signature before submitting a claim. Guidance is available in the CMS article Guidance on Beneficiary Signature Requirements for Ambulance Claims.

Beneficiaries refusing to sign for claim submission to Medicare for payment are responsible for the full bill. CMS allows ambulance suppliers to refuse services.