It appears likely that the Centers for Medicare & Medicaid Services (CMS) will withdraw its new policy that requires a physician’s or qualified non-physician practitioner’s (NPP) signature on all paper requisitions for clinical diagnostic laboratory tests that are paid for under the Medicare Clinical Laboratory Fee Schedule. On November 29, 2010, CMS in its final rule defined a “requisition” as the actual paperwork, such as a form, which is provided to a laboratory that indentifies the test or tests to be performed for a patient. Enforcement of this rule was previously delayed from January 1, 2011 until April 1, 2011 to allow for additional provider education on the new requirements.
While CMS has not made an official announcement regarding this matter; clinical laboratory associations have reportedly received notice from CMS that it intends to officially withdraw the policy prior to its scheduled enforcement date of April 1, 2011. CMS’ decision may have been in part based on bipartisan letters that were sent from the United States House of Representatives and the Senate requesting that CMS delay enforcement of the policy for up to an additional nine months. Both legislative bodies expressed concern that more time was needed to discuss the potentially serious implications on patient care and business practice. Such concerns included a potential delay in the provision of urgent patient care in the event laboratory services were needed but a physician or NPP was not available to sign the requisition.
Current CMS policy requires an order from a physician, but no signature is required on orders for clinical diagnostic tests paid on the basis of the clinical laboratory fee schedule, the physician fee schedule, or for physician pathology services. Instead, the physician must clearly document, in the medical record, his or her intent that the test be performed. See Medicare Benefit Policy Manual, Chapter 15, Section 80.6.1.
We will continue to update this blog in the event that CMS formally withdraws its plan to change the current policy.