College of American Pathologists
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December 21, 2010
© 2010 College of American Pathologists
Special Report
Breaking News: CMS Delays Requisition Signature Requirement

The Centers for Medicare & Medicaid Services (CMS) announced on Dec. 21 that it will delay implementation of the Physician Fee Schedule (PFS) Final rule provision requiring a physician’s or qualified non-physician practitioner’s (NPP) signature on all requisitions for tests paid on the Clinical Laboratory Fee Schedule (CLFS) that was scheduled to go into effect on Jan. 1, 2011.

It appears that the delay will be through the first quarter of 2011, although the agency did not detail a specific end date for the delay. “Although many physicians, NPPs, and clinical diagnostic laboratories may be aware of, and are able to comply with, this policy, CMS is concerned that some physicians, NPPs, and clinical diagnostic laboratories are not aware of, or do not understand, this policy,” stated the agency on its website. “As such, CMS will focus in the first calendar quarter of 2011 on developing educational and outreach materials to educate those affected by this policy…Once our first quarter of 2011 educational campaign is fully underway, CMS will expect requisitions to be signed.”

In addition to the notice of delay, a CMS official confirmed to the CAP that the signature requirement only applies to test requisitions paid on the CLFS and not the PFS—a source of confusion when the final rule was published in late November. “There have been numerous ongoing questions surrounding the requirement for signature on laboratory tests,” stated the official. “Because of the confusion surrounding this subject, and because the new regulation brought this confusion to the forefront, CMS has decided to develop educational and outreach materials as a teaching tool. We will take into consideration all of the questions presented to us to form the basis for our training material.”

Advocacy Efforts

The decision to delay the requirement comes after the College—along with other clinical laboratory organizations—wrote to CMS Administrator Donald Berwick, MD, in mid-December, urging a delay and requesting a meeting to discuss the potential negative implications of this new requirement. The Dec. 12 letter also noted the CAP’s concern about this requirement in comments submitted to CMS prior to the final PFS rule.

In addition to this letter, the CAP joined with fellow members of the Clinical Laboratory Coalition (CLC) in expressing opposition earlier last month. Writing to CMS Deputy Administrator Marilyn Tavenner on Dec. 3, the groups asked for a delay until at least the beginning of 2012.

The CAP continues to work with other provider groups and engaging with CMS to make them aware of the potential negative impact that this new requirement could have on health care providers, as well as the confusion resulting from this requirement.

CMS Will Continue to Delay PECOS Enforcement

CMS has announced that it will not enforce the expected January 2011 enrollment deadline by rejecting claims of those providers who receive orders from referring/ordering practitioners who are not enrolled in the agency’s Provider Enrollment, Chain and Ownership System (PECOS).

In an agency transmittal, officials indicated that the system’s automated edits to reject claims would not be “turned on” in the near future. These edits automatically deny claims for services that were ordered or referred by a physician or other eligible professional who do not have an approved file in PECOS. “CMS is working diligently to resolve backlog and other system issues and will provide ample advance notice to the provider and beneficiary communities before CMS begins any such automatic denials,” stated the transmittal.

CMS originally anticipated that the PECOS enrollment date would be in early January 2011. This date was moved up six months to early July 2010 under the new health care law. However, the July implementation date was delayed amidst enrollment problems and concern from physicians that that their claims would be rejected if the referring or ordering physician listed on the claim was not enrolled in PECOS.

Despite this most recent announcement, CMS is encouraging physicians to enroll in PECOS “sooner rather than later”. To verify an enrollment record in the system, visit the agency’s PECOS website.

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