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Welcome news it was for independent clinical labs and hospital labs serving nonhospital patients when the Centers for Medicare and Medicaid Services (CMS) expunged from the books the requirement for the signature of a physician or nonphysician practitioner (NPP) on paper test requisitions.

These labs in particular would have had great difficulty in obtaining these requisitions from referring doctors and NPPs and would be financially at risk if the test were performed without the signed order.

CMS formally rescinded the controversial signature requirement in the final 2012 Medicare physician fee schedule rule. CMS had formalized the requirement in the 2011 fee schedule rule but never implemented it after running into a firestorm of opposition from lab and physician groups and then proposed to scrap it.

Bad News and Unknowns
In the wake of the policy reversal, clinical laboratories should consider some bad news and some unknowns, cautions attorney Robert E. Mazer with Ober|Kaler in Baltimore. Take a closer look, he advises, at the expectations CMS set for labs at the same time that it retracted the maligned policy.

CMS does not appear “willing to abandon totally the physician signature requirement,” Mazer notes, pointing to CMS’s comments in the preamble to the final 2012 rule. The agency restated its position thus: “The requirement that the treating physician or NPP must document the ordering of the test remains, as does our longstanding policy that requires orders, including those for clinical diagnostic laboratory tests, to be signed by the ordering physician or NPP.”

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