2025 Medical Review Officer Online Course with Live Discussion (Includes Digital Syllabus)-Tab 10: Medical Review Officer Practice

Tab 10: Medical Review Officer Practice

Pdf Summary

This comprehensive guideline outlines the role and best practices for Medical Review Officers (MROs) in managing drug testing under Department of Transportation (DOT) and other regulatory frameworks. The MRO acts as the gatekeeper of the testing process, responsible for receiving and reviewing laboratory drug test results, verifying positives, interviewing donors, and reporting outcomes while ensuring workplace safety.<br /><br />Key MRO duties include evaluating results (negative, positive, adulterated, substituted, invalid, and dilute specimens), conducting donor interviews using a standardized checklist, and offering split specimen analysis when required. MROs must review Custody and Control Forms (CCF) for errors, document all findings meticulously, and maintain confidentiality.<br /><br />Positive results require MRO verification of legitimate medical explanations, especially regarding prescription drug use. The guideline stresses caution with opioid testing—highlighting federal cutoffs, metabolism complexities, and the opioid overdose crisis—while clarifying that substances like medical marijuana are not federally accepted medical explanations. MROs must be vigilant against prescription forgery and assess safety risks related to drug use and medications, reporting these concerns to employers following DOT protocols, including a mandated 5-day pause allowing prescribing physicians to respond.<br /><br />For adulterated or substituted specimens, the MRO treats these as equivalent to positive tests, requiring interviews and often reporting them as refusals to test unless a legitimate medical explanation is provided. The handling of invalid and dilute specimens is also detailed, including retest requirements and reporting.<br /><br />The guidelines stress that MRO interviews are not clinical patient encounters or investigations but focused reviews to clarify test results. Recordkeeping requirements and distinctions between DOT and non-DOT testing scenarios are highlighted. The document also addresses legal considerations around workplace drug testing, including state laws and new testing methodologies like oral fluid testing, as well as emerging challenges such as expanded opioid testing.<br /><br />Overall, these practical recommendations empower MROs to ensure testing accuracy, donor rights, employer compliance, and the health and safety of safety-sensitive workplaces.

Keywords

Medical Review Officer

MRO duties

drug testing

Department of Transportation

DOT regulations

positive drug test verification

opioid testing guidelines

donor interviews

specimen adulteration

workplace safety