What you should know about the MRO Drug Testing Process
Written by Lucas Kibby, CleanFleet
It Can Take Up To 10 Days to Complete the MRO Review Process for a Drug Test Result
This is the 3rd part of a 3 part series describing the lifecycle and potential delays of a drug test. The previous articles describe errors being made at collection sites and the lab’s testing process and how it affects result times.
Once a donor’s sample is sample is tested by a laboratory, the result is sent to a Medical Review Officer (MRO) for review. A MRO is a licensed physician who is responsible for reviewing and evaluating medical explanations for drug test results.
MROs act as independent and impartial “gatekeepers” and advocate for the accuracy and integrity of the drug testing process. They provide quality assurance review of the drug testing process for the specimens under their purview, determine if there are legitimate medical explanations for laboratory confirmed positive, adulterated, substituted and invalid drug test results, ensure the timely flow of test results and other information to employers and protect the confidentiality of the drug testing information.
In order to review federal drug tests results, MROs must be certified by one of two associations: the American Association of Medical Review Officers or the Medical Review Officer Certification Council. Once certified, MROs must follow strict federal regulations when reviewing federal test results. This process can take up to 10 days before results can be released.
The Medical Review Process of a Drug Test Result
When MROs receive lab results, they match the results with Copy 2 of the CCFs in which are received from the collection sites. If an MRO doesn’t have Copy 2 of the CCF, that result cannot be reviewed until the CCF is received, and someone has to work with collection sites to obtain the CCF. This is the number one delay of test results.
After CCFs are obtained and matched to results, MROs review the documentation to ensure there are no fatal flaws which would cancel the tests. Negative test results then get reported to employers or TPAs. For non-negative results, such as positives, regulations state MROs follow the process outlined below.
Step 1: MRO attempts to reach the donor
The MRO must attempt to reach the donor 3 times in the first 24 hours. If the MRO cannot make contact with the donor, the MRO notifies the donor’s employer that the MRO needs to speak with the donor. The employer’s DER (Designated Employer Representative) then must make 3 attempts (text, email, phone) to reach the donor in 24 hours, documenting each attempt.
If the DER makes contact with the donor, the DER notifies the MRO that contact has been made, and the donor has 72 hours to contact MRO back. If there is no contact back to the MRO by the donor within the 72 hours, the MRO releases the result as is to the employer.
If the DER cannot make contact with the donor about contacting the MRO, the MRO must hold the result for 10 days before releasing it to the employer. Be sure to note that the employer has a role to play before the results are submitted to the company’s DER.
Step 2: The MRO/Donor Interview
In the MRO confidential interview, the MRO determines whether the donor wants to discuss the test result. In making this contact, the MRO must explain to the donor that, if he/she declines to discuss the result, the result will be reported as a positive or refusal to test because of adulteration or substitution, as applicable.
The MRO must tell the driver that the laboratory has determined that the donor’s test result was positive, adulterated, substituted, or invalid, as applicable and which drugs his/her specimen tested positive for or the basis for the finding of adulteration or substitution.
The MRO must explain that, if further medical evaluation is needed for the verification process, the driver must comply with the MRO’s request for this evaluation and that failure to do so is equivalent to expressly declining to discuss the test result.
If there is no prescription or medical reason for the positive test, the MRO verifies the positive result.
If the donor claims to be using a prescription, the donor has 5 days to present the prescription to the MRO. The MRO then contacts the pharmacy or prescribing physician to verify the prescription and that dosage prescribed is consistent with the levels found in the donor’s sample. If the prescription is validated the MRO will report a negative result to the employer.
This process can take up to two weeks because every part of the process has a rule and when the rule is not followed, delays will occur.
Managing the Testing Process is Complex, However, CleanFleet Is Here to Help!
Drug testing involves much more than having a donor provide a sample in a cup. There are a lot of moving parts, and if even one part gets hung up, the entire process comes to a halt. Some delays are avoidable, however, a lot of times the test needs to go through its process.
CleanFleet knows the importance of getting results to employers as soon as possible. We have a dedicated team that mitigates avoidable delays and keeps employers informed of where tests are in their processes.
If you need help managing the testing process, read more here or fill out the form below.