According to CMS’s CY-2011 Physician Fee Schedule Final Rule to be published on November 29, 2010, a Physician or Non-Physician Mid-Level Practitioner (NPP) will be required to sign a laboratory requisition for tests reimbursed from the Part B Clinical Lab Fee Schedule (CLFS) beginning January 1, 2011.
The rule distinguishes between “requisitions” and “orders.” CMS defines a requisition as “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. It may contain patient information, ordering physician information, referring institution information, information about where to send reports, billing information, specimen information, shipping addresses for specimens or tissue samples, and checkboxes for test selection.”
CMS adds that a written order, which may be part of the medical record, and the requisition are two different documents, although a requisition that is signed may serve as an order.
CMS says that this rule does not concern electronic or telephonic requests, because CMS does not consider these types of requests to be requisitions.
CMS states that “our policy does not require a physician or NPP to use a requisition to request a clinical diagnostic laboratory test paid under the Part B CLFS. Many physicians and NPPs currently request clinical diagnostic laboratory tests using an order, such as an annotated medical record or documented telephonic request, and they may continue to do so without being impacted by our new policy for requisitions.”
An order may be delivered via any of the following forms of communication:
- A written document signed by the treating physician/practitioner, which is hand-delivered, mailed, or faxed to the testing facility;
- A telephone call by the treating physician/practitioner or his or her office to the testing facility; or
- An electronic mail, or other electronic means, by the treating physician/practitioner or his or her office to the testing facility. If the order is communicated via telephone, both the treating physician/practitioner, or his or her office, and the testing facility must document the telephone call in their respective copies of the beneficiary’s medical records.
CMS concludes that “we are finalizing our proposed policy without modification to require a physician’s or NPP’s signature on requisitions for clinical diagnostic laboratory tests paid under the CLFS. This policy does not affect physicians or NPPs who choose not to use requisitions to request clinical diagnostic laboratory tests paid under the CLFS. Such physicians or NPPs can continue to request such tests by other means, such as by using the annotated medical records, documented telephonic requests, or electronically. We will make changes to our manuals to reflect this final policy.”
The rule is effective January 1, 2011. Although the rule is “Final,” there is a comment period through January 3, 2011. We are attaching instructions (Attachment #1, Federal Register) for submitting your comments.
Due to the January 1, 2011, effective date, we recommend that you take steps to revise paper requisitions to include a signature line for the physician or NPP to sign. You should also prepare and forward notifications to physicians, NPPs, and other test ordering clients of the new signature requirements. Currently, it is not known if CMS will allow a later implementation date or if signatures will be required for all dates of service on and after January 1, 2011.
These new signature requirements are still less than “clear.” We will be forwarding additional information as more information becomes available. Attachment #2 contains CMS’s Final Rule to be published in the Federal Register on November 29, 2010.
