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A Model Attestation Statement for Laboratories

by | Mar 28, 2022 | Articles, Essential, Lab Compliance Advisor, Tool

To guard against reimbursement denials due to improper signatures, labs can give MACs an attestation statement from the physician or NPP.

Medicare won’t pay for lab tests or other services unless the ordering physician or non-physician practitioner (NPP) legibly signs or marks a document indicating his/her knowledge, approval, acceptance, or obligation to the services provided. If the signature is missing or illegible, the medical reviewer may refuse to pay for the associated test. One of the things your lab can do to guard against such denials is to give your Medicare administrative contractor (MAC) an attestation statement from the physician or NPP to authenticate the illegible or missing signature. While format requirements may vary by MAC, under Medicare rules, an attestation statement is deemed valid for medical review purposes as long as it includes:
  • The physician or NPP’s full printed name;
  • Sufficient information to identify the beneficiary;
  • The date of service; and
  • The signature and date by the author of the medical record entry.
Here’s a template you can adapt based on the attestation format requirements, if any, of your particular MAC:

Statement of Attestation

“I, [print full name of the physician/NPP], 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 Medicare beneficiary. 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.”

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