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Press Start: Lead an Empowered Life as a Clinical Laboratorian

CMS Rescinds Physician Signature Requisition Requirement

Published February 22, 2011 6:13 PM by Glen McDaniel

I have always been a little uncomfortable with the saying "the squeaky wheel gets the oil."  I understand the sentiment, but I did not philosophically agree that one had to be loud or confrontational to be heard.

I have to say that in the case of the CMS requirement for physician signature on lab requisitions, the laboratory community was the squeaky wheel that got the oil!

In the 2011 Medicare Physician Fee Schedule Final Rule, published in the Nov. 29, 2010 edition of the Federal Register, the Centers for Medicare and Medicaid Services (CMS) stated its intention to begin requiring physician signatures on all laboratory requisition forms reimbursable by Medicare beginning on Jan. 1 of this year.

In typical CMS fashion, a combination of housekeeping issues and protests from stakeholders caused CMS to move the implementation date to April 2011.  But in any event it seemed that it was going to be a done deal.

Asked for clarification, CMS made it clear that "laboratory requisition forms are those documents provided to a clinical diagnostic laboratory that identify the test or tests to be performed, but they are not considered to be physician orders that heretofore required a physician's signature."

While laboratorians saw the need for physician orders to be signed they realized the difficulty of ensuring that requisitions were signed as well.

Most concentrated not just on the difficulty of ensuring such a requirement and the impact it would have on laboratories, but pointed out the various ways in which patient care would suffer.

In a rare show of unity laboratory professional groups (ASCLS, ASCP, AACC and AMT),  American Clinical Laboratory Association (ACLA) representing industry, and other stakeholders flooded CMS with calls, emails and faxes. They created in effect a huge squeak!

In a clear response to this outcry, it was announced that CMS is rescinding that requirement

Laboratorians can breathe a sigh of relief. More importantly they can pat themselves on the back for the fact that in this one case (unlike so many others) they actually did something other than whine and wring their hands.

They not just squeaked, they found their voice and roared. Let's hope that having found their voice, laboratorians won't lose it again.

4 comments

I am so glad because I kept thinking there is no way we could meet that requirement. Patients would come in and get mad at the lab if we did not do their lab work. Then we know for sure  doctors would threaten us if we did not do it also. So I was afraid we would end up doing the work then try to get the signature afterward. In any case we would probably just not get paid for most of our outpatient work. I wonder if CMS is just postpoing this law until sometime later.

Lucy M. , Chemistry Super February 26, 2011 6:09 PM
New Brunswick NJ

I now work in the Bahamas, but was trained in Chicago, IL. I worked in the states for years.  One of the things I can never understand when I look around me is how other professionals in healthcare  (doctors, nurses, physiotherapists, even dietitians) are getting their just due. They are becoming more important in healthcare and to the public. Everyone recognizes their worth, but not the value of med techs.%0d%0a%0d%0aIt is not a coincidence that these people have started bossing us around and ordering lab tests. Years ago who heard of a dietitian or pharmacist ordering a lab test?  Now they order tests and we have to perform them however inapropriate.%0d%0a%0d%0aBelieve it or not most countries are better off than the US. Even though we might not have the same license as a nurse, employers hire only trained certified med techs for lab work  in other countries.%0d%0a%0d%0aWe need the LAW in the states (USA) to make sure that MTs and MLTs are licensed.  The only way that will happen is if lab folks speak up and keep speaking up.

Pholemon Thomas MT (ASCP) February 23, 2011 6:30 PM
Nassau, Bahamas

I now work in the Bahamas, but was trained in Chicago, IL. I worked in the states for years.  One of the things I can never understand when I look around me is how other professionals in healthcare  (doctors, nurses, physiotherapists, even dietitians) are getting their just due. They are becoming more important in healthcare and to the public. Everyone recognizes their worth, but not the value of med techs.

It is not a coincidence that these people have started bossing us around and ordering lab tests. Years ago who heard of a dietitian or pharmacist ordering a lab test?  Now they order tests and we have to perform them however inapropriate.

Believe it or not most countries are better off than the US. Even though we might not have the same license as a nurse, employers hire only trained certified med techs for lab work  in other countries.

We need the LAW in the states (USA) to make sure that MTs and MLTs are licensed.  The only way that will happen is if lab folks speak up and keep speaking up.

Pholemon Thomas MT (ASCP) February 23, 2011 6:28 PM

It would be even nicer if those same voices could stay united and have that same effect on Congress with respect to recognizing us as professionals by supporting licensure, and by providing separate funding for lab training programs to help meet current and future needs.,

Monica Newby, ML:T (ASCP) February 22, 2011 6:38 PM

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