• CMS Clarifies Interpretive Guidelines on Use of Standing Orders, Pre-Printed Orders and Signature Stamps in Hospital
  • November 17, 2008 | Author: Nancy C. LeGros
  • Law Firm: King & Spalding LLP - Houston Office
  • In the final version of the update to Appendix A of the State Operations Manual, CMS removed a statement that would have required hospital staff to obtain an order from the responsible practitioner before administering drugs or biologicals in accordance with written protocols or standing orders (October 24, 2008 Survey Memo S&C-09-10).

    CMS made the change based on concerns that such a requirement could impede the timely delivery of care, especially in emergency situations. As revised, the interpretation permits the physician to sign off on implementation of the standing orders after they have been implemented. The survey memo also specifically permits use of pre-printed order sets (which may be used to establish standing orders or protocols) if they have been approved by the hospital’s medical staff and the responsible practitioner documents as follows: (i) signs, dates and times the last page of the order set; (ii) initials each page containing “check” boxes for selection of an optional order; and (iii) initials each place where the practitioner revises the order set through additions, deletions or strikeouts. If the order set is contained in a single electronic document, the practitioner only needs to sign, date and sign the final order. The survey memo acknowledges that signature stamps are permitted in a hospital setting when properly controlled (i.e., only the practitioner uses the stamp). However CMS noted that some contractors do not view the signature stamp as sufficient to support a claim for payment (certain Medicare contractors (e.g., Noridian) also have published policies holding standing orders as insufficient to show medical necessity for the service).