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The CMS updated policy regarding test orders reads: “a written order for diagnostic tests…(for example, that are paid under the Physician Fee Schedule (PFS) or under the Outpatient Prospective Payment System (OPPS), such as X-rays, MRIs, …must be signed by the ordering physician or NPP.” Acceptable forms of signature include: • Legible handwritten signature • Illegible handwritten signature, but only if the illegible signature can be confirmed on the order a) Typed or printed name underneath the illegible signature or initials b) Prescription pad with providers listed and the specific ordering provider circled • Electronic or digitized signature containing a printed validation statement and date and time stamp a)“Electronically signed by (physician/NPP) on (date) at (time)” This information is being presented to you for your convenience.

In effect, he's creating a paper trail to defend himself against the possibility that you will sue him later.

In confirming its position, CMS specifically states: “For medical review purposes, Medicare requires that services provided/ordered be authenticated by the author.

The method used shall be a handwritten or an electronic signature.

The more tests doctors run in their own offices, the more they get paid for, whether or not a patient really needs them.

Since we patients are rarely paying directly for them, and since we don't really understand why we need them, we don't question them. The second reason doctors order too many tests is called "defensive medicine." Defensive medicine is the way doctors protect themselves from lawsuits.

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