• CMS Announces 3-Month Reprieve from the Physician Signature Requirement on Requisitions for Laboratory Tests
  • January 3, 2011 | Author: Susan Banks
  • Law Firm: King & Spalding LLP - Washington Office
  • Effective January 1, 2011, all requisitions for clinical diagnostic laboratory tests paid on the basis of the clinical laboratory fee schedule must be signed by a physician or qualified nonphysician practitioner.  See MPFS Final Rule, 75 Fed. Reg. 73170, 73480-83 (Nov. 29, 2010).  Laboratories performing reference testing for Medicare patients are very concerned that they will have to absorb losses resulting from physician noncompliance with this new requirement.  In response to these concerns, CMS has announced that it will delay enforcement of this requirement until it is able to educate physicians about the new policy.  CMS will spend the first quarter of 2011 developing educational and outreach materials that will be posted on the CMS website.  “Once our first quarter of 2011 educational campaign is fully underway, CMS will expect requisitions to be signed.”

    Although a physician’s or practitioner’s signature has long been required on written orders for clinical laboratory tests, requisitions have not previously required a signature as long as it is evident that a physician or qualified practitioner ordered the services.  CMS has defined an “order” as “a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary.”  A “requisition,” on the other hand, is “the actual paperwork, such as a form, which is provided to a clinical diagnostic laboratory that identifies the test or tests to be performed for a patient.”  CMS views requisitions as essentially ministerial documents that serve as an administrative convenience to providers and  patients.  Although there is lingering confusion over the distinction between the two types of documents, the new signature requirement for requisitions parallels the signature requirement for written orders.

    There is no requirement that physicians and practitioners use requisitions to request clinical diagnostic laboratory tests.  Tests may still be requested through other means that do not implicate the new signature requirement, including through the use of annotated medical records, documented telephonic requests, or electronically.  For telephone orders to be found proper upon audit, they must be supported by the record in the physician’s office as well as the laboratory’s records.  It is likely that in an audit, the burden would be on the laboratory to obtain copies of the physicians’ office records to support a telephone order.  Electronic orders should have electronic signatures which conform to applicable requirements.