CMS proposes to rescind lab requisition signature requirement

HCPRO Website, June 30, 2011

Signature requirements still in flux after latest NPRM

by Andrea Kraynak, CPC
After 10 years, the requirements for signatures on lab requisitions are still in flux.
CMS is now proposing to rescind the requirement for signatures on all lab requisitions that it previously finalized in the 2011 Medicare Physician Fee Schedule (MPFS) last November, according to the “Medicare Program; Clinical Laboratory Fee Schedule: Signature on Requisition” notice of proposed rulemaking (NPRM) published in today’s Federal Register.
“This is great news,” says Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., in Danvers, MA. “This is one instance where the comments of providers, labs, and other stakeholders were considered in greater detail and they made a positive impact on the final outcome.”
Per the 2011 MPFS final rule, a physician’s or nonphysician provider’s (NPP) signature is currently required on lab requisitions for tests paid under the clinical lab fee schedule, regardless of whether there is a signed order. This is the opposite of prior CMS rulings that indicated signatures were not required on requisitions, although written and signed orders were required.
The requirement was scheduled to take effect January 1, however, in light of significant commentary by the healthcare industry, CMS granted a delay in enforcement in December 2010 so providers could conduct education and outreach during the first quarter of 2011.
“It was during that time that CMS decided to re-examine the policy instead,” Mackaman says.
CMS had since hinted that the requirement might be rescinded, but that doing so would require additional rulemaking as it had already been finalized in the 2011 MPFS rule. Today’s proposed rule fulfills that requirement.
“Stakeholders provided excellent examples of how the real world works when ordering labs in a variety of scenarios. This just goes to show that we must take the initiative to comment on proposed rules because it can make a positive impact on CMS rulings,” Mackaman says. “[CMS] began to understand the burden this would place on providers since the requisition is primarily a ‘business document’ to initiate a test, often used by staff per a provider’s order. The order and/or documentation to support the service is still required so signing a request to initiate a test was considered to be redundant and unnecessary.”
CMS also states in the rule that it underestimated the effects the signature requirement could have on quality of care and patient safety as providers took time to obtain signatures. This is especially true for providers without electronic health records or for those who hadn’t combined their requisition and order form into a single document.
The requirement for signatures on lab requisitions was mainly an effort on the part of CMS to continue to reduce fraud and improper payments.
“This is still a main concern and CMS is maintaining its long iterated stance that the burden of proof that the test was actually ordered by the physician or NPP is on the lab that is performing the service,” Mackaman says. “Hospital labs and independent labs need to make sure they have sufficient policies and procedures in place to ensure this and prevent recoupments during future external audits.”
Editor’s note: Click here to view the NPRM in the June 30, 2011 issue of the Federal Register. Click here to view the 2011 MPFS final rule.

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