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Promoting and Preserving the Highest Quality of Standards Among MROs and Their Teams.

MRO INFORMATION

DEFINITION OF A MEDICAL REVIEW OFFICER
A Medical Review Officer (MRO) is a licensed physician who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for non-negative drug test results.

The MRO acts as an independent and impartial "gatekeeper" and advocate for the accuracy and integrity of the drug testing process. The MRO provides quality assurance review of the drug testing process for the specimens under his or her purview, determines if there is a legitimate medical explanation for laboratory confirmed positive, adulterated, substituted and invalid drug test results, and ensures the timely reporting of test results and other information to employers and protects the confidentiality of the drug testing information.
MRO responsibilities
The MRO has the following responsibilities:

Review all positive, adulterated, rejected for testing, invalid, and (for urine) substituted test results;
Ensure that specimens reported as negative and (for urine) negative/dilute are properly reviewed and reported to the agency's designated representative. The MRO must review at least 5% of the negative results reported by staff to ensure the MRO staff are properly performing the review process. This review should include all specimens that required corrective action;
Discuss potential invalid results with the HHS-certified laboratory to determine whether further testing at another HHS-certified laboratory is warranted;
Complete action on a report from an HHS-certified laboratory or (for urine) HHScertified IITF by

Reviewing the information on the MRO copy of the Federal Custody and Control Form (CCF) that was received from the collector and the report received from the HHS-certified laboratory or IITF;
Interviewing the donor when required (e.g., to verify the existence of prescribed medication that could explain the result and/or to collect evidence of the prescription and subsequent dispensing of that prescription);
Making a determination regarding the result; and
Reporting the verified result to the federal agency.

Maintain all records for a minimum of 2 years while maintaining the confidentiality of the information. The MRO may discard hardcopy records 6 months after conversion to electronic records (with appropriate security);
Conduct a medical evaluation of the donor or a review of the examining physician's findings and make a determination of "refusal to test" or "cancelled test" when a collector reports that the donor was unable to provide a urine specimen;
Monitor the frequency of errors and notify responsible parties to take corrective action to prevent recurrence; and
Review the results of federal agency blind samples and perform the initial investigation into discrepant results.
Request additional testing (as allowed) to help in the determination of a final result for a donor specimen.

More detailed information about the Medical Review Officer field is available at the links below:

MROCC MRO Competencies
DOT 49 CFR Part 40: Procedures for Transportation Workplace Drug and Alcohol Testing Programs
SAMHSA: Medical Review Officer Guidance Manual for Federal Workplace Drug Testing Programs

REQUIREMENTS

INITIAL CERTIFICATION
The MROCC Initial Certification examination is open to those physicians who have had appropriate MRO training from an MROCC-approved MRO training course sponsored by ACOEM, AOCOPM, or AAMRO. To apply for the initial certification examination a physician must:

have graduated from a medical school or school of osteopathic medicine
hold a valid and unexpired medical license (MD or DO) to practice within the U.S., its territories, a province of Canada, or a country in which the physician resides and practices. If any license is limited, suspended, or revoked, the applicant must notify MROCC in writing upon submission of their application. All adverse actions resulting in limitations, suspension, or revocation will be reviewed by MROCC on an individual basis. No approval of an application will be granted until the review has been completed.
have completed, within the past 12 months, an MROCC-approved MRO training course sponsored by ACOEM, AOCOPM or AAMRO

RECERTIFICATION
MROCC Recertification examination is open to physicians who are (or were previously) certified by MROCC or AAMRO. DOT requires MROs to complete retraining and pass a recertification examination every five years. To apply for the recertification examination a physician must:

have current or previous certification by MROCC or AAMRO
hold a valid and unexpired medical license (MD or DO) to practice within the U.S., its territories, a province of Canada, or a country in which the physician resides and practices. If any license is limited, suspended, or revoked, the applicant must notify MROCC in writing upon submission of their application. All adverse actions resulting in limitations, suspension, or revocation will be reviewed by MROCC on an individual basis. No approval of an application will be granted until the review has been completed.
have completed approved MRO retraining in the 5 years preceding the examination (training used previously to fulfill the requirements to get certified/recertified as an MRO cannot be reused). The retraining requirement may be fulfilled by either the MROCC "At Home" Self-Study CME activity or an MROCC-approved MRO training course.

EXAM DATES AND FEES

EXAM DATES
There are both online and onsite MRO Certification and Recertification examinations offerings. The online examination is offered year round and can be taken on the date/time of the examinee's choosing. Onsite exams are paper based and administered following select onsite courses. Course registration is separate and is completed through the course sponsor.

MROCC APPROVED TRAINING (Initial and Recertification):
ACOEM and AOCOPM offer onsite training options in the Spring each year. Additionally, ACOEM offers an online recorded MRO training course that is available throughout the year. Both online and onsite courses are acceptable training for Initial Certification and Recertification. Upcoming course/examination opportunities are as follows:

ONLINE OFFERINGS

ACOEM COURSE
FORMAT: Online Recorded Course
COURSE: Medical Review Officer Online Course
CREDITS: ACCME designates this activity for a maximum of
18.5 AMA PRA Category 1 Credits™.
PHONE: (847) 818-1800
WEBSITE:
https://acoem.org/Learning/MRO-Resources

ONSITE OFFERINGS
AOCOPM MRO TRAINING COURSE
Location: Kansas City, MO
Course Dates: March 17, 2023 - March 18, 2023
Exam Date: NO ONSITE EXAM OFFERED
Exam Start Time: COURSE ONLY; ONLINE EXAM AVAILABLE
Sponsor: AOCOPM
Course website:
https://www.aocopm.org/opam-workshop-mro

ACOEM MRO TRAINING COURSE
Location: Philadelphia, PA
Course Dates: April 14, 2023 - April 15, 2023
Exam Date: April 16, 2023
Exam Start Time: TBD
Sponsor: ACOEM
Course website:
https://acoem.org/American-Occupational-Health-Conference-(AOHC)/2023-Program

COURSE CONTACT INFORMATION

ACOEM COURSE
CONTACT: Danielle Feinberg
PHONE: (847) 818-1800
WEBSITE:
https://acoem.org/Learning/MRO-Resources

AOCOPM COURSE
CONTACT: Ronda LeBoeuf
PHONE: (800) 558-8686
WEBSITE: https://www.aocopm.org/

MROCC FEES
MROCC examination and CME fees are as follows:
INITIAL CERTIFICATION:

$525 INITIAL CERTIFICATION EXAM: Online/Onsite examination following completion of approved MRO training course through ACOEM, AOCOPM, or AAMRO (Course fee/registration separate)

RECERTIFICATION:

$525 RECERTIFICATION EXAM ONLY: Online/Onsite examination following completion of approved MRO training course through ACOEM, AOCOPM, or AAMRO (Course fee/registration separate)
$695 RECERTIFICATION EXAM AND SELF-STUDY CME ACTIVITY: 25 Hour MROCC Self-Study CME Activity and Recertification Examination ($170 for 25 Hours of CME; $525 for online/onsite recertification exam). Cost of 6th edition MRO Manual used in the self-study CME activity is separate and purchased through OEM Press).

MROCC CME ACTIVITY ONLY:

$170 15 Hour MROCC Self-Study CME/Self-Assessment Activity (does not include recertification examination)

PROFESSIONAL-PRINTED CERTIFICATE:

$37 Professional-printed Certificate

EXAM DETAILS AND REGISTRATION

CERTIFICATION AND RECERTIFICATION
MROCC certification is DOT and SAMHSA recognized and approved. The examinations are based on 49 Code of Federal Regulations (CFR Part 40) and the MRO Competencies Document. As mandated by the Department of Transportation, MRO certification is valid for five years, at which time recertification is required to remain within DOT compliance and in the directory of currently-certified MROs.

State-of-the-art psychometric procedures are employed for scoring and the determination of the minimum passing level. Scores are determined and reported based upon the total number of items answered correctly. There is no penalty for guessing. Passing scores are not determined on the basis of subcategory scores.
MROCC EXAMS
All MROCC MRO certification/recertification examinations are $525. MRO training courses, self study CME activity, and MRO Manual are separate costs. Details on the specific examination options are listed below.
ONLINE EXAMINATIONS
INITIAL CERTIFICATION (Physicians who are being certified as an MRO for the first time)

Available to physicians who have completed an MROCC-approved MRO training course within the last 12 months
Convenient, web-based platform accessible from any computer
Immediate pass/fail decision upon submission
Open book format
Consists of 110 multiple choice questions
Examinees have up to 3 hours to complete
Must be taken in one sitting (no logging on/off)
One free retest is allowed

RECERTIFICATION (Physicians who are or have been previously certified as an MRO by MROCC or AAMRO)

Available to physicians who have submitted the MROCC 25 Hour Self-Study CME activity OR completed an MROCC-approved MRO training course within the last 5 years
Convenient, web-based platform accessible from any computer
Immediate pass/fail decision upon submission
Open book format
Consists of 100 multiple choice questions
Examinees have up to 30 days to complete once the exam is started
Log on/off privileges
Two free retests are allowed
Great, no-travel option for recertification when combined with the MROCC 25 Hour Self-Study CME Activty

ONSITE PAPER EXAMS
INITIAL CERTIFICATION (Physicians who are being certified as an MRO for the first time)

Available to physicians who have completed an MROCC-approved MRO training course within the last 12 months
Consist of 110 multiple choice questions
Allow 3 hours for completion
Are closed book format
Have results available within 4-5 weeks of the examination
Are proctored, paper/pencil examinations
Are administered in conjunction with approved MRO training courses
One free retest is allowed

RECERTIFICATION (Physicians who are or have been previously certified as an MRO by MROCC or AAMRO)

Available to physicians who have submitted the MROCC 25 Hour Self-Study CME activity OR completed an MROCC-approved MRO training course within the last 5 years
Consist of 110 multiple choice questions
Allow 3 hours for completion
Are closed book format
Have results available within 4-5 weeks of the examination
Are proctored, paper/pencil examinations
Are administered in conjunction with approved MRO training courses
Two free retests are allowed

EXAM PREPARATION

EXAM RESULTS AND CME CERTIFICATES

RETESTS

MROCC RETEST POLICY
While we hope that everyone who takes the examination will pass it; we know realistically that there are many factors which can interfere with performance. In recognition of these possible complicating factors, the MROCC Board has adopted a policy on retests.
Initial Certification Retests
The retest policy permits the examination to be taken one additional time for free within 12 months of completion of the MRO course. An email with information on logging into the retest is sent out within 48 hours of the failure notice. If you do not pass the retest, a new application and full examination fee will be required before attempting the examination again. Completion of a new MRO course will be necessary if it has been more than 12 months since completion of the course.
If you have already completed your retest opportunity, please log into your record at https://www.mrocc.org/app_choices.cfm and select "I have exhausted my retest attempts, I need to reapply" to complete your application and pay the examination fee.
Recertification Retests
The retest policy permits the examination to be taken two additional times for free within a 12 month period from the date of registration for recertification. An email with information on logging into the retest is sent out within 48 hours of the failure notice. If after two retests, you have not passed the recertification examination, a new application and full examination fee will be required before attempting the examination again.
If you have already completed your retest opportunities, please log into your record at https://www.mrocc.org/login.cfm and select "Recertify Now" to complete your application and pay the examination fee.
Review Prior to Retesting
Weaknesses and strengths within each of the MRO competencies are included as part of your examination results. Examinees who do not pass the examination, should review these areas to determine where to focus their studying prior to taking the retest.
Resource Links by Subject Area
      Substance Abuse
      Clinical Aspects
      Collections and Procedures
      Regulatory Issues
      Toxicology, Pharmacology and Lab Issues

NAVIGATING THE ONLINE EXAMINATION

THE PROCESS...WHAT TO EXPECT

TEAM MEMBER/ASSISTANT INFORMATION

WHAT IS AN MRO TEAM MEMBER?

TEAM MEMBER DEFINITION
The MRO can be assisted by one or more staff. An MRO team member performs administrative functions and does not perform any portion of the interview between the MRO and donor. The administrative functions typically include receipt and sorting of test forms, presenting non-negative and fatally flawed files to the MRO for review, and distribution of reports to clients. Some MRO team members also call donors, confirm their identity, and then transfer the calls to the MRO.

Some MRO team members are also involved in the corroboration of medical explanations that donors may present to the MRO. An MRO team member should be detail-oriented, well organized, and reliable. Under the U.S. Department of Transportation (DOT) drug and alcohol testing procedures, the MRO must supervise the MRO team member. This supervision must include personal oversight of that team member's work; personal involvement in evaluating, hiring, and firing the team member, line authority over the team member for decisions, direction, and control; and regular contact and oversight concerning drug testing program matters. The MRO's supervision and control cannot be superseded by or delegated to anyone else with respect to test result review and other functions performed by the MRO team member.

BENEFITS OF CERTIFICATION
This three-year certification -- awarded upon successful completion of approved training and passing of the MRO Team Member online examination -- acknowledges competency in those practical skills the MRO Team Member applies in fulfilling his or her professional responsibilities within the workplace drug testing arena. Within both Regulated and Non-Regulated testing programs, the MRO Team Member must understand and be confident in his or her role and that of the physician MRO -- maintaining a clear and thorough comprehension of what the team member can and cannot do; defining the issues that arise during the medical review process and the best courses of action to tackle these issues; providing services to the physician MRO that meets standards of professionalism, accountability, and ethical behavior; and implementing practical application of industry standards and procedures. An MROCC-Certified MRO Team Member provides assurance to the MRO, the employer, and the donor duties are performed in a consistent and professional manner, ensuring integrity and confidentiality throughout the entire drug testing process.

REQUIREMENTS AND APPROVED COURSES

INITIAL CERTIFICATION
MRO Team Member certification is valid for three years. Initial MRO Team Member Certification is open to non-physician Team Members who assist and are directly supervised by a certified Medical Review Officer. MRO Team Member initial certification candidates are required to:

Complete an MRO Assistant training course sponsored by ACOEM, ALCOPRO, DATAC, DATIA, or SAPAA. The course must have been completed within the 24 months preceeding registration for certification.
-- OR --
Training Waiver: Individuals who have a minimum of three year's experience as an MRO Team Member may waive the training course requirement with a letter of recommendation from a currently certified MRO. The letter must be from an MRO who has worked with the team member for a minimum of one year, and has knowledge of his or her competency as an MRO Team Member.
Take and Pass the current MRO Team Member certification examination

Documentation of MRO Assistant Training course must be submitted at the time of registration. Certificate of course completion or registration confirmation/receipt from the course provider is acceptable.
RECERTIFICATION
MRO Team Member recertification is offered to those who currently hold or previously held MRO Team Member (or MRO Assistant) certification. MRO Team Member certification/recertification is valid for three years. Candidates for MRO Team Member recertification are required to:

Submit a letter of recommendation from the supervising MRO attesting to the Team Member's competency
Read MRO Team Manual: MROCC'S Guide for MROs and MRO Team Members available from OEM Press, and complete/submit the Self-Assessment tool with their registration.
OR
Alternate Training: Recertifying MRO Team Members may substitute the self-assessment by attending any of the available MRO Assistant training courses sponsored by ACOEM, ALCOPRO, DATAC, DATIA, or SAPAA
Take and Pass the current MRO Team Member certification examination

Completed Self-Assessment tool or documentation of approved MRO Assistant Training course must be submitted at the time of registration, along with the letter of recommendation from the supervising MRO.
APPROVED TRAINING
While MROCC does not offer MRO Team Member/Assistant training, the following organizations offer courses throughout the year. Please use the contact information below to obtain information regarding training opportunities:

American College of Occupational and Environmental Medicine (online course)
ACOEM website Phone: 847.818.1800
ALCOPRO (online courses)
ALCOPRO website Phone: 800.227.9890
The Drug & Alcohol Testing Association of Canada (online courses)
DATAC website Phone: 866-324-7093
The Drug and Alcohol Testing Industry Association (onsite and online courses)
DATIA website Phone: 800.355.1257
The Substance Abuse Program Administrators Association (online course)
SAPAA website Phone: 800.672.7229