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You are here: Home . wc . news . advisories . ad2002-03

Advisory 2002-03

Medical Fee Dispute Resolution - Medical Signatures

The Texas Workers' Compensation Commission provides the following clarification regarding the signatures of licensed health care providers on medical reports, SOAP (Subjective/Objective Assessment Plan/Procedure) notes, interdisciplinary program notes, office notes, physical or occupational therapy notes, or any medical documentation of service(s)/treatment(s) rendered for which a licensed health care provider is seeking medical fee dispute resolution.

If the insurance carrier (carrier) disputes reimbursement for medical services based on the failure of the licensed health care provider to sign his/her medical documentation, the Medical Review Division will review the file based on that denial code in addition to any other denial codes the carrier had provided prior to the filing of the request for dispute resolution. The carrier may use the denial code, "N", which means "Not appropriately documented", on the TWCC-62 (Explanation of Benefits), along with the explanation of "no signature".

It is recommended that the licensed health care provider sign any medical documentation submitted to the Medical Review Division to support reimbursement. A stamped signature is acceptable if it has been placed on the documentation with the authorization of the health care provider. This confirms that the service(s)/treatment(s) were administered by the billing provider. Interdisciplinary team members should sign the medical documentation for the service(s)/treatment(s) they rendered. The lack of a signature may result in an adverse decision.

If the health care provider has inadvertently not signed his/her medical documentation, he/she may submit a signed statement, attached to the pertinent documentation, that the provider affirms/swears that the service(s)/treatment(s) documented were rendered by that/those provider(s). This signed statement should be dated, contain the printed name of the person signing, and submitted with the dispute resolution request or response to that request.

Signed this 11 th day of February, 2002

Richard F. Reynolds, Executive Director

Distribution:
TWCC Staff
Medical Professional Associations
Carrier Representatives
Forms Notification List
Public Information List
TWCC web site



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