MRO Cheat Sheet 2026

The 30 highest-yield MRO facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. A specimen arrives at the laboratory with a broken seal. What change does the laboratory make to the result before sending it to the MRO? → The lab reports it as rejected for testing
2. Under DOT 49 CFR Part 40, how often must a laboratory submit blind quality control specimens to the HHS-certified laboratory it contracts with? → At least once per month
3. An employer wants to use an on-site instant test device for DOT-mandated testing. What is the MRO's correct guidance? → Prohibit it; DOT requires HHS-certified lab testing
4. A split specimen (Bottle B) retest is requested by the donor. Which party typically pays the initial cost of the retest? → The donor pays upfront and may be reimbursed if confirmed negative
5. Which factor most significantly drives differences in MRO review pricing between providers? → Volume of specimens reviewed and included ancillary services
6. An MRO contract clause prohibiting the vendor from hiring the employer's employees for two years after contract termination is called a: → Non-solicitation of employees clause
7. What is the PRIMARY purpose of continuing education requirements in Contract Closeout Procedures for MRO professionals? → Maintaining current knowledge and competency as the field evolves
8. During a donor interview, the donor states they took Marinol (dronabinol) by prescription. How does this affect an MRO's review of a THC-positive result? → The MRO should verify the prescription and may report negative
9. What initial testing method is required for DOT federal workplace urine drug screening? → Immunoassay
10. An MRO reports a verified positive drug test result directly to a small employer. What is the employer's immediate required action? → Remove the employee from safety-sensitive duties immediately
11. An employer instructs the MRO to automatically report all positive results to a specific supervisor rather than to the designated DER. The MRO should: → Follow the DOT-defined reporting chain and report to the properly designated DER
12. A verified positive result is reported for oxycodone. The donor provides a valid prescription for OxyContin. What should the MRO report? → Negative, because a legitimate prescription was provided
13. Under DOT regulations, an MRO may release a verified positive drug test result directly to which of the following without employee consent? → The employer's designated employer representative (DER)
14. Under DOT regulations, who has the sole authority to verify and report the final result of a federally mandated drug test? → The Medical Review Officer (MRO)
15. An MRO's QA program should track the rate of 'fatal flaws' on custody and control forms (CCFs). A fatal flaw is defined as an error that: → Requires the specimen to be cancelled because it cannot be corrected
16. Under 49 CFR Part 40, which of the following CCF errors is considered a 'fatal flaw' that requires the MRO to cancel the test? → No specimen ID number on the CCF and specimen bottle seal
17. Why is specimen validity testing performed? → To ensure specimen integrity
18. What is the minimum number of days an HHS-certified laboratory must retain a negative urine specimen before discarding? → 30 days
19. Under DOT regulations, how must the MRO conduct the verification interview with the donor? → By telephone or in person, on a confidential basis
20. Under DOT 49 CFR Part 40, a laboratory certified by HHS that loses its certification must: → Transfer all pending specimens to another HHS-certified laboratory immediately
21. A C/TPA selects employees for random testing from a consortium pool. Who is responsible for ensuring the selected employees are actually tested? → Each individual employer of the selected employees
22. What is the minimum urine specimen volume required for a DOT federal workplace drug test? → 30 mL
23. A 'clawback' provision in an MRO contract would allow the employer to recover previously paid fees if: → The MRO loses their certification after services were rendered
24. During contract closeout, what must happen to specimens collected but not yet tested at the laboratory? → Testing must be completed before closeout finalizes
25. A fixed-price MRO contract that bundles specimen collection, laboratory fees, and MRO review into one per-test rate is best described as which contract type? → Bundled per-transaction contract
26. An MRO's contract requires maintaining errors and omissions (E&O) insurance. This coverage primarily protects against claims arising from: → Professional mistakes or negligence in MRO review decisions
27. Which of the following best describes the role of the Designated Employer Representative (DER) during contract closeout? → The DER coordinates record transfer, verifies receipt, and ensures program continuity
28. When reviewing a positive cocaine metabolite result, the donor states they had dental anesthesia with cocaine. What is the MRO's correct response? → Verify the dental procedure documentation and report negative if confirmed
29. During contract closeout, the MRO identifies 3 CCFs with no corresponding laboratory results. What is the correct next step? → Investigate whether specimens were received by the lab and follow up until resolved
30. When a federal contractor's employee in a safety-sensitive position tests positive, the MRO must report the verified positive result to which entity first? → The employing contractor's designated employer representative (DER)