Take advantage of the delay
During the implementation delay, reach out to your medical staff and educate them on the CMS regulations and why these are important for them, Reisinger says. Consider revising your requisition forms to include a prompt for the physician to sign the requisition. Reach out to nursing homes, home health organizations, and other agencies your facility works with, and educate them as well.
"This delay is certainly a benefit for hospitals so they can take time now to work with the different providers from whom they receive requisitions for lab services," says Shah. "When CMS releases educational material on this issue, hospitals may find it easier to have a concrete dialogue about the CMS requirement with its physicians and NPP partners."
Reisinger wasn't surprised by the delay, in part because of the letter sent by the AHA and others. "The onus is on us to make sure the changes are in place," Reisinger says. "We're going to be the ones seeing the denials come through. We needed the time, so I'm very grateful, but I'm not surprised."
Don't be surprised if the rule is delayed again, Reisinger says. "It is going to be a huge burden for hospitals." Hospitals are unlikely to turn away patients because the physician didn't sign the requisition, but if CMS does not delay it again, the question of the financial impact will be very interesting, Reisinger says.
"I don't think that CMS will overturn this rule this year, but may modify it somewhat in the coming rulemaking process for 2012," Mackaman adds.
Another question that arises is how diligent and aggressive CMS will be in reviewing records for signatures. "I don't know if they will take it as far as the RACs or whether they will be focused reviews," Reisinger says. "There's a lot of burden placed on facilities to make sure we're in compliance with this and we don't get the denial of payment."
Providers are basically in a wait-and-see mode now, Shah says. The outreach material could help predict which way things will go. "If the material is forthcoming, we can anticipate that this delay will be over at some point," Shah says. "If it's not forthcoming, it's quite possible that this could be delayed further and further and quite possibly repealed altogether based on the opposition CMS has received and continues to receive."