Pathology/Lab Coding Alert

CMS to halt April implementation.

The new requirement for physician signatures on lab test requisitions won't happen after all, according to a CMS statement to lab groups that lobbied to halt the change.

First the Jan. 1, then the April 1 deadlines passed for referring physicians and non-physician practitioners (NPP) to personally sign all paper requisitions for clinical lab tests.

Labs breathe sigh of relief: "The new policy was going to mean a big change, because existing Medicare policy specifically does not require a physician signature on clinical lab test requisitions," says Stan Werner, MT (ASCP), administrative director of Peterson Laboratory Services PA in Manhattan, Kan.

Lab Groups Announce CMS Retraction

The American Association of Bioanalysts (AAB) and National Independent Laboratory Association (NILA) -- groups that spearheaded a lobbying effort against the physician signature rule -- announced that CMS "has determined the physician signature rule is unworkable and that the best thing to do is to pull it back in its current form."

An official CMS notice revising the rule is forthcoming, according to the AAB/NILA announcement, which you can read at www.aab.org/aab/NewsBot.asp?MODE=VIEW&ID=86&SnID=1113175208.

Know Current Rules

The Medicare Benefit Policy Manual (CMS IOM Pub. 100-02, chapter 15, §80.6.1) states that no signature is required "for clinical diagnostic tests paid on the basis of the clinical laboratory fee schedule, the physician fee schedule, or for physician pathology services." The new requirement put forward in the 2011 PFS final rule would supersede this long-standing policy.

"By stating that the agency won't implement the physician signature requirement on April 1, CMS reverts to the standard put forth in the Benefit Policy Manual," says Larry Small, MS, MT(ASCP), CEO and Managing Partner of Lab/Path Consulting in Tierra Verde, Fla.

Get Proactive for Signatures

Does that mean you should forget CMS's most recent physiciansignature scare and maintain the status quo in your lab?

"I don't think that the physician signature requirement is gone forever," Small says. Note that CMS said only that it would "pull it back in its current form."

Do this: "Labs should understand the latest recommendation and prepare to comply, even though CMS won't implement the change in April," Small advises. "Put a signature space on requisitions when you're reprinting, and begin to train staff and clients to get a signature."

Better yet: "Work to move your lab toward electronic orders that don't require a signature," Small says.

To help you understand what almost happened, and what labs might face in the future if CMS decides to reprise this rule, read on for a review of the policy that CMS published in the 2011 Physician Fee Schedule (PFS) final rule (Nov. 29, 2010 Federal Register):

Understand Signature Scope -- That Almost Was

CMS states in the 2011 PFS that the new physician/NPP signature requirement is for requisitions for clinical diagnostic lab tests paid under the Clinical Laboratory Fee Schedule (CLFS).

Paper only: The signature requirement would have applied only to paper requisitions. "This policy does not affect physicians or NPPs who choose not to use [paper] 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," according to the PFS final rule.

Anatomic pathology -- maybe: Although the PFS policy would have required physician/NPP signatures for paper requisitions for clinical diagnostic lab tests paid under the CLFS, some experts believe the requirement would have extended to tissue specimens for anatomic pathology.

That's because CMS states that the change would mean a physician's signature would be "required for all requisitions and orders, eliminating uncertainty over ... which payment system does or does not require a physician or NPP signature." CMS goes on to define a requisition as "the actual paperwork, such as a form ... which may contain ... information for specimens or tissue samples..." (emphasis added) Taken together, these statements imply that physicians or NPPs must also sign requisitions accompanying anatomic pathology specimens.

Rescinding the physician/NPP signature requirement put forth in the 2011 PFS final rule will make all these considerations null and void.

"This is a pivotal issue for CMS, so be prepared to deal with the matter another day," Small cautions.