Medicine Wins; CMS Drops Lab Signing Rule

Admitting it did not fully understand the impact of what it was requiring, the Centers for Medicare & Medicaid Services (CMS) now says it will drop a proposed rule [PDF] that the ordering physician or nonphysician practitioner (NPP) must sign requisitions for all clinical diagnostic laboratory tests paid under the clinical laboratory fee schedule.

CMS said it made the decision "based on continued and new concerns noted by stakeholders regarding the practical effect of the finalized policy on beneficiaries, physicians, and NPPs. Even in cases where the physician or NPP sees the patient in his/her offices for an appointment and recommends that clinical diagnostic laboratory testing be performed, we now better understand that, typically, the information is transcribed from the medical record onto a paper requisition by office staff after the physician or NPP and the patient have concluded their interaction. In practice, we can see how requiring the physician or NPP to sign the paper requisition could, in some cases, be very inconvenient and disruptive to the physician, NPP, the beneficiary, and other patients."

Earlier this year, TMA, numerous specialty societies, hospitals, and several members of Congress, including U.S. Rep. Michael Burgess, MD (R-Texas), asked CMS to delay the rule until next year. Representative Burgess was among a bipartisan group of House and Senate members who wrote CMS requesting the delay because of the "the myriad potential harmful consequences of this policy on Medicare beneficiaries' timely access to laboratory testing."

Representative Burgess said he is glad CMS "made the right decision in pulling this provision back so that we can put patient care first. The new enforcement was unnecessary and went beyond delaying care, Medicare beneficiaries could end up spending a lot of their time contacting providers to get required signatures, and providers could see their payments delayed or worse, possibly denied for a new administration hurdle. Creating more bureaucracy in a system that can sometimes already be hard to navigate only creates more problems. Patients, physicians, hospitals, nursing homes, and laboratories could not afford to have this change implemented, and all supported this effort."


Action, July 5, 2011


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