Physician Order Authentication FAQs

LabCheck Electronic Signature Authentication Requirement


  1. Why is Ascend Requiring Physician Authentication of Each Patient’s Laboratory Order?

    Medicare requires that the ordering physician authenticate intent to order and medical necessity. Failure to do so can result in the submission of improper claims to Medicare. In order to assure that our physicians and Ascend meet all documentation requirements, Ascend Clinical will provide a no-cost, electronic signature solution, effective early 2017.

    This simple, electronic signature solution will be required on each patient’s order. For standing orders, referring physicians must electronically authenticate the order, codes, and all requested tests on at least an annual basis, depending on the periodicity of the order.

  2. Why is Medicare Now Targeting Clinical Labs, Physicians and Clinics?

    The Federal Officer of the Inspector General (OIG) has identified Medicare’s payments to clinical labs as a source of high error rates that have resulted in improper payments to providers.

    The OIG’s Workplan for 2017 has identified “Monitoring Medicare Payments for Clinical Diagnostic Laboratory Tests – Mandatory Review” as a priority initiative for 2017. These reviews will build upon the OIG’s Workplan for 2016 that targeted end-stage renal disease facilities and payments for renal dialysis services and drugs.

    Medicare may also impose significant fines and penalties if it is determined that false claims have been submitted to Medicare and, potentially, exclude providers from participation as a Medicare provider.

  3. What are the Most Common Lab Service Errors?

    The majority of improper payments for lab services identified by the Comprehensive Error Rate Testing (CERT) Program were due to insufficient documentation, including the physician’s failure to document intent to order, a signed physician order, and insufficient documentation to support medical necessity.

    For example, Medicare’s guidance entitled “Complying with Documentation Requirements for Laboratory Services,” states that the physician should clearly indicate in the progress notes all tests to be performed. The note that states “run labs” or “order labs” by itself does not support intent to order.

  4. Why is Ascend Contacting the Referring Physician or the Clinic for Medical Record Documentation?

    Centers for Medicare and Medicaid Services (CMS) is reviewing clinical labs’ claim submissions. CMS requires the clinical lab to ensure that all claims are supported by signed medical record documentation for both the physician’s intent to order and medical necessity. CMS requires the lab to provide the signed documentation upon request. If the clinical lab does not have the supporting documentation – e.g., a signed order – then CMS requires the lab to contact the clinic and referring physician to obtain the signed, medical record documentation.

    Federal law – The Social Security Act Section 1842 (p) (4) requires the referring physician or clinic to provide Ascend with the required documentation that supports all submitted claims.

    “In case of an item or service…ordered by a physician or a practitioner…but furnished by another entity [e.g., Ascend Clinical], if a fiscal agent of the Secretary of Health and Human Services requires the entity furnishing the item or service to provide diagnostic or other medical information in order for payment to be made to the entity, the physician or practitioner shall provide that information to the entity at the time that the item or service is ordered by the physician or practitioner.”

    Therefore, CMS requires Ascend to contact you, the referring physician, to obtain the medical records to verify that Medicare coverage criteria have been met – including documentation of intent to order, medical necessity, and a signed order. Your cooperation is required by the Social Security Act. Failure to provide the record documentation to Medicare can result in the recoupment of payments or denial of payments for services provided.

  5. What Are Medicare’s Documentation Requirements?

    As a participating provider in the Medicare program, the federal government demands that Ascend make a good faith effort to ensure all tests requested by a physician are performed and billed in a manner consistent with law and regulations. Moreover, we are required to inform you of the requirements. Following are excerpts from Medicare publications that clarify Medicare’s requirements:

    • A “signed order is the simplest way to document provider’s intent and medical necessity.”

      (“Avoiding Improper Payments – Ordering and Referring Services, Noridian Part B Medicare Administrator Contractor,” July 2016)

    • “The physician must clearly document and sign in the medical record, his or her intent to have the test performed.”

      (“Avoiding Improper Payments – Ordering and Referring Services, Noridian Part B Medicare Administrator Contractor,” July 2016)

    • “Insufficient documentation errors include:
      • Incomplete progress notes (for example, unsigned, undated, insufficient detail);
      • Unauthenticated medical records (for example, no provider signature); and
      • No documentation of intent to order services (for example, incomplete or missing signed order).”

        (“Complying with Medical Record Documentation Requirements – DHHS/CMS”)

      • “The medical record must demonstrate medical necessity, including sufficient documentation to support the need— e.g., the patient’s diagnosis, duration of the patient’s condition, clinical course (worsening or improvement), prognosis, nature and extent of functional limitation, other therapeutic interventions and results, and any other information that establishes the need for the service. Medical Necessity is what decides whether Medicare services may or may not be paid. “

        (“Avoiding Improper Payments – Ordering and Referring Services, Noridian Part B Medicare Administrator Contractor,” July 2016)

  6. How Will the Physician Authenticate Laboratory Orders?

    Ascend provides an electronic signature solution which is simple and intuitive known as LabCheck eSign.

  7. What Can Happen if Neither the Lab or Physician Provide the Signed Documentation?

    The Office of the Inspector General (OIG) takes the position that a physician who orders medically unnecessary tests, for which Medicare or Medicaid reimbursement is claimed, may be subject to civil penalties under the False Claims Act.

    “Labs should inform physicians that the OIG takes the position that an individual who knowingly causes a false claim to be submitted may be subject to sanctions or remedies under civil, criminal and administrative laws.”

  8. What Can the Referring Physician and Our Facility Do to Assure We Comply with all Medicare’s Documentation Requirements?
    1. Ensure that you, the referring provider, understand the documentation requirements and can provide, upon request, signed documentation for intent to order and medical necessity. The statement “order tests” or “run tests” does not meet the documentation requirement.
    2. Ensure that you, the referring physician, have signed, authenticated standing laboratory orders for each of your patients on at least an annual basis. An unsigned requisition form is not a signed order.
    3. Access Medicare’s training and resource manual “Avoiding Improper Payments – Ordering and Referring Services, July 2016” within LabCheck.
    4. Ensure that you provide your electronic signature to authenticate all orders in LabCheck eSign.
  9. What Resources are Available to Learn More about this Requirement?
    1. Watch a webinar recording
    2. Download CMS Fact Sheets:
      1. Complying with Documentation Requirements for Laboratory Services
      2. Complying with Medicare Signature Requirements