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What Is Medical Review?

Posted on Monday, February 20th, 2023

By Adam Hall, Staff Writer & Editor at Current Consulting Group (CCG)

This information is provided for educational purposes only. Reader retains full responsibility for the use of the information contained herein.

The medical review component of the drug testing process is no less critical than any other; however, it can be easily discounted as a minor step in drug testing. Interactions between a Medical Review Officer (MRO), donor, or MRO staff member can be brief, and almost always occurs behind the proverbial closed door. However, a drug testing process without medical review could lead to unreliable or inaccurate results.

Even a modest understanding of the medical review process can be beneficial to both employers and donors. Knowledge of this process provides key details as to why a result is reported a certain way, if a retest is necessary, or if an applicant or employee has a valid medication prescription. In this article, we will take a closer look at the role of the MRO, the MRO assistant, and how the medical review process works.

The Medical Review Officer

Federal regulations state that in order to qualify to act as an MRO you must be a licensed physician, including both Doctors of Medicine (MD) or Osteopathy (DO). Additionally, qualified MROs must be knowledgeable about controlled substance abuse disorders, along with maintaining a solid understanding of issues relating to adulterated and substituted specimens and invalid results. Although all drug testing does not adhere to federal requirements, the criteria established at the federal level is widely accepted as the industry standard for all medical review services.

The primary responsibility of the MRO is to serve as the gatekeeper of results prior to their release to an employer. Many individuals use prescription medications, many of which will show up on a standard employment drug test. The MRO is tasked with discussing with the donor any medication they may be using that could account for a laboratory’s findings, verify that the prescription is legitimate, and ultimately send a final verified result to the employer. What this means is that a laboratory result may be different than a final MRO-verified result, but the change was made after the MRO obtained satisfactory information regarding the donor’s medication.

The medical review process is not limited to one type of testing. MROs are also responsible for understanding different testing methodologies. Urine, saliva, and hair testing are common methods used for workplace drug testing, so an MRO must have a comprehensive understanding of how to interpret laboratory results for these different sample types.

The MRO Assistant

Similar to how doctors work with other medical staff in clinical settings, such as nurses or medical assistants, MROs may also lean on a support staff to aid in the review process. After all, many MROs are still practicing physicians maintaining other jobs in between reviewing results. These support staff members are commonly referred to as MRO assistants. An MRO may have only one assistant or multiple, depending on the volume of results coming through their office.

MRO assistants support an important but sometimes thankless role in the review process. Clerical work, such as data entry or filing, is often left for MRO assistants to complete. They may also coordinate phone calls between the MRO and donor, MRO and pharmacy, or report results to employers on behalf of the MRO. The MRO determines the level of responsibilities for their assistants while adhering to the limitations set forth by applicable rules and regulations.

The Review Process

Each MRO may navigate the review process in different ways, but the objective for each case is the same. Once a sample has been tested by the laboratory, that result is then sent to the MRO for review. A negative result can simply be passed on to the employer, often by the MRO assistant. If a laboratory result is positive, the MRO will need to reach out to the donor to conduct an interview. These interviews are usually conducted over the phone as it is common for MROs to operate in different states from where the testing occurred.

During the interview, the MRO will introduce themselves to the donor and verify that they are speaking to the correct person. They will discuss the laboratory findings, and the donor is afforded an opportunity to disclose any medications they may be taking to account for the result. If necessary, the MRO will verify prescription information, and make a final determination as to what the result should be. This high-level view of the overall interview and verification process can be as short as a few hours or take as long as multiple days. The MRO may lean on their assistants to provide support as directed.

Lastly, an MRO may receive a result from a laboratory indicating that the sample was adulterated or substituted. Additional validity testing information is provided from the lab as well, such as pH levels, specific gravity, etc. In these situations, the MRO will still interview the donor to discuss the laboratory findings. Depending on the validity test findings, the MRO may order a retest which would possibly be collected under direct observation, or cancel the test all together and discuss next steps with the employer. In addition to the aforementioned qualifying criteria that MROs must meet, they must also thoroughly understand the regulations and requirements applicable to the type of test they are reviewing in order to determine the final outcome of a test.


While most of their role is handled behind the scenes, MROs and their assistants play a vital role in maintaining the integrity of the drug testing process. They conduct donor interviews, review prescription medication claims, verify information with pharmacies or prescribing physicians, and combine the donor-specific information and their medical expertise to determine a final test result.

© 2010-2023 The Current Consulting Group, LLC – No portion of this article may be reproduced, retransmitted, posted on a website, or used in any manner without the written consent of the Current Consulting Group, LLC. When permission is granted to reproduce this article in any way, full attribution to the author and copyright holder is required.

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