Under intense industry and Congressional pressure, the Centers for Medicare and Medicaid Services (CMS) has withdrawn a provision included in the 2011 Medicare Physician Fee Schedule Final Rule that would have required physician signatures on all laboratory requisition forms reimbursable by Medicare. Laboratory requisition forms are documents provided to a clinical diagnostic laboratory identifying the tests to be performed.
A coalition of several national laboratory associations, including the National Independent Laboratory Association and the Clinical Lab Coalition, joined by other groups such as the American Hospital Association and the American Medical Association, led an effort to rescind the rule and persuade CMS that the requirement would create numerous patient care concerns and logistical operational challenges.
In a letter to CMS Acting Administrator Dr. Donald M. Berwick and subsequent in-person meetings with CMS officials, the organizations argued that the new policy could cause significant harm to patients and cause laboratories that serve a large number of Medicare beneficiaries to possibly shut their doors. An independent cost analysis of the new requirement showed the impact on small physician and laboratory businesses would be in the hundreds of millions of dollars. The nursing home industry voiced its concern that about the costs associated with the new provision especially in emergency situations.
Members of Congress — 89 House members (40 Democrats, 49 Republicans) and 34 Senators (19 Democrats, 15 Republicans) — were concerned enough about the unintended consequences of the new signature requirements to send letters to CMS asking the agency to address the cost and quality of care issues raised by the health care community.
As a result of the health care community's concerns, CMS has rescinded the physician signature requirement for clinical laboratory requisition forms. A revised rule has yet to be published.