The Medicare Hospital Condition of Participation permitting the authentication of verbal orders by someone other than the ordering practitioner will expire in six months. Will you be ready?

Federal regulations (at 42 C.F.R. 482.24(c)) require that all orders be authenticated promptly by the ordering practitioner. In 2007, a provision was added that allowed, for a temporary period of five years, another treating practitioner – other than the ordering practitioner – to authenticate verbal orders. That five year temporary period ends on January 26, 2012. The regulations provide:

482.24(c)(1)(i) - All orders, including verbal orders, must be dated, timed, and authenticated promptly by the ordering practitioner, except as noted in paragraph (c)(1)(ii) of this section.

482.24(c)(1)(ii) - For the 5 year period following January 26, 2007, all orders, including verbal orders, must be dated, timed, and authenticated by the ordering practitioner or another practitioner who is responsible for the care of the patient as specified under §482.12(c) and authorized to write orders by hospital policy in accordance with State law.

CMS explained the regulations in the Interpretive Guidelines as follows:

In some instances, the ordering practitioner may not be able to authenticate his or her verbal order (e.g., the ordering practitioner gives a verbal order which is written and transcribed, and then is “off duty” for the weekend or an extended period of time). In such cases, for a temporary period expiring on January 26, 2012, it is acceptable for another practitioner who is responsible for the patient’s care to authenticate the verbal order of the ordering practitioner. CMS provided this temporary exception in order to take account of differences among hospitals in their rate of adoption of electronic medical record systems that would permit the ordering practitioner to easily and efficiently authenticate an order in all circumstances.

But in six months this options ends and hospitals must comply with 42 C.F.R. 482.24(c)(1)(i), which requires that all orders, including verbal orders, be authenticated promptly by the ordering practitioner. Note that 42 C.F.R. 482.24(c)(1)(iii) provides that the timeframe for “prompt” authentication of verbal orders is defined by State law or, if there is no State law designating a specific timeframe, verbal orders must be authenticated within 48 hours.

Hospitals should begin reviewing what changes will be necessary to ensure compliance with this CoP on January 26, 2012. Specifically, hospitals should review their Medical Staff Bylaws or policies on authentication of verbal orders and revise as necessary.

It is possible that this deadline could be extended, given that the reasons for the original five year reprieve may still largely exist. We will provide additional updates in the event of an extension.