In the November 28, 2011 Federal Register, the Centers for Medicare and Medicaid Services ("CMS") retracted its requirement that physicians or non-physician practitioners ("NPPs") sign requisitions for clinical laboratory tests paid under the Clinical Laboratory Fee Schedule ("CLFS").
When it was first enacted ten years ago, in 2001, CMS revised 42 CFR 410.32(d)(2) to require that "[t]he physician or [sic] (qualified nonphysician practitioner, as defined in paragraph (a)(3) of this section), who orders the service must maintain documentation of medical necessity in the beneficiary's medical record." In its comments, CMS repeatedly noted that "[w]hile the signature of a physician on a requisition is one way of documenting that the treating physician ordered the test, it is not the only permissible way of documenting that the test has been ordered." Until CMS' release of the final CY 2011 Physician Fee Schedule ("PFS"), this remained CMS' position and the healthcare industry's practice.
In the CY 2011 PFS, CMS proposed and finalized a rule to require a physician's or NPP's signature on requisitions for clinical diagnostic laboratory tests paid on the basis of CLFS. However, after becoming increasingly aware of the difficulty with which this new requirement was being implemented and realizing the potential negative impact it could have on the delivery of care, CMS retracted its new signature requirements, reinstating the old rule:
After consideration of the public comments received, we are finalizing our proposal to retract the policy that was finalized in the CY 2011 PFS final rule with comment period, which required a physician's or NPP's signature on a requisition for clinical diagnostic laboratory tests paid under the CLFS (75 FR 73483) and to reinstate our prior policy that the signature of the physician or NPP is not required on a requisition for a clinical diagnostic laboratory test paid under the CLFS for Medicare purposes.
Therefore, physician or NPP signatures are no longer required on requisitions for clinical laboratory tests paid under CLFS.