FI encourages electronic signature use

The Internet has, in theory at least, made life a little easier for all of us. Barring computer viruses, Internet-server provider problems, and other unforeseen mishaps of the computer age, the Internet has allowed us to communicate seamlessly in real-time. The business world clearly has benefited from these advances and so, too, has the health care sector.

One area that has seen a great deal of recent innovation is that of electronic signatures. As reported in Hospital Home Health’s October issue, regional fiscal intermediaries (FIs) are now accepting electronic signatures. But in case you’re still a little confused as to what you should be doing, let alone why you should be doing it, HHH spoke with James W. Cope, MD, medical director of United Government Services LLC (UGS) on how his Milwaukee, WI, company has implemented e-signature programs.

He points out that the benefits of using e-signatures really are clear. First is the ease of documentation, "and certainly from our point of view, electronic records are easier to read. Poor handwriting isn’t just a doctor problem. E-signatures allow for less chance of error. On top of everything, it’s easier for our providers to get records to us. The whole deal is easier — less storage and fewer trees dying. In this day and age, there really are no cons to using an electric signature."

That, of course, is provided that all the proper policies and procedures are in place. What are those policies and procedures? Home care pro-viders should refer to HIM-11 section 204.2(H) for guidance in establishing policies and procedures related to electronic signatures. In particular, policies should address:

• authentication and dating of signatures, which may include signatures, written initials, or use of a unique identifier;

• prevention of unauthorized access;

• procedures for rebuilding records if the system breaks down.

UGS, as Cope points out, has delineated its electronic signature from those policies and "we have towed the line pretty closely."

To those agencies who are interested in implementing an e-signature program, he recommends that they start in one of two ways. They may, of course, "write us saying they have a new procedure in place and [ask] how [to] get approved for it," Cope says, adding that such a step would be the exception rather than the rule. "In most cases, people develop a procedure based on Section 204.2 and start using it. When we receive documents they have submitted with an electronic signature, we check our records to see if they are on the list of providers approved to use e-signatures. If not, we immediately call them and ask for verification of the policies and procedures they have put in place to safeguard the system.

"Once we receive the appropriate documentation, and it’s usually by fax to save time, we make sure it contains [information] required by 204.2," Cope continues. "If it does, then they are as of that moment approved. Providers can even be approved retroactively."

UGS has sent out explanatory materials in some of its recent publications. Still, he says that if an agency has questions, it is encouraged to call the company. "I’m sure our nurses will be more than happy to guide them along if they have particular questions related to that section."

Just as the e-signature policy guidelines are among the clearest written, Cope notes that the five intermediaries are striving to smooth regional differences. In the case of e-signatures, in particular, he points out that "all five of the regional intermediaries do accept electronic signatures in essentially the same manner." This is one of the few areas where there is national unity and not regional differences, he says.

"We are trying to do things and make policies as uniform as possible. We are starting to move away from regional differences in medical care. I think this is a little step in the right direction."

[For more information, contact: James W. Cope, MD, Medical Director, United Government Services LLC, 401 W. Michigan St., Milwaukee, WI 53203. Telephone: (877) 908-8474. E-mail:]