Medical Review Officer (MRO) Certification Exam — Questions and Answers

Question 1: Which federal regulation outlines the procedures for drug testing in the workplace?

21 CFR Part 11
49 CFR Part 40 (Correct answer)
29 CFR Part 1910
42 CFR Part 2

Correct answer: 49 CFR Part 40

49 CFR Part 40 is the federal regulation that defines the procedures for workplace drug and alcohol testing programs.

Question 2: How should an MRO handle confidential medical information collected from donors when transitioning records to a new MRO?

Email unencrypted files to expedite transfer
Use secure encrypted transfer methods and obtain written authorization where required (Correct answer)
Provide only aggregate summaries without identifying information
Retain all medical information and never transfer it

Correct answer: Use secure encrypted transfer methods and obtain written authorization where required

Confidential medical information must be transferred using secure, encrypted methods to protect donor privacy consistent with HIPAA and DOT privacy requirements.

Question 3: What does a 'negative-dilute' result indicate?

Positive with interference
Diluted sample with no drugs (Correct answer)
Invalid sample
High drug concentration

Correct answer: Diluted sample with no drugs

A negative-dilute result means the sample was diluted but no drugs were detected; a retest may be required based on policy.

Question 4: A split specimen (Bottle B) retest is requested by the donor. Which party typically pays the initial cost of the retest?

The MRO pays upfront
The donor pays upfront and may be reimbursed if confirmed negative (Correct answer)
The employer pays upfront
The laboratory pays upfront

Correct answer: The donor pays upfront and may be reimbursed if confirmed negative

The donor must pay for the split specimen retest upfront, but if the result is reported negative or invalid, the employer must reimburse the donor.

Question 5: In Cost & Pricing Analysis, what is the FIRST step a MRO professional should take when encountering a new case or situation?

Implement an immediate solution based on past experience
Conduct a comprehensive assessment and gather all relevant information (Correct answer)
Consult with a supervisor before taking any action
Document the situation and wait for further instructions

Correct answer: Conduct a comprehensive assessment and gather all relevant information

In Cost & Pricing Analysis, a thorough initial assessment ensures all relevant factors are identified before deciding on an appropriate course of action. This systematic approach is fundamental to Medical Review Officer practice.

Question 6: An MRO is reviewing a specimen that was shipped to the laboratory via a non-approved courier. Under 49 CFR Part 40, what is the most appropriate action?

Contact the courier to obtain shipping records
Accept the result if the seal is intact (Correct answer)
Cancel the test due to a fatal flaw in chain of custody
Report the result as dilute

Correct answer: Accept the result if the seal is intact

Shipping method is not a fatal flaw under Part 40; if the specimen seal is intact and the CCF is properly completed, the MRO may proceed.

Question 7: What ethical issue arises if an MRO shows bias in result interpretation?

Better lab coordination
Improved employee satisfaction
Faster turnaround time
Loss of impartiality and trust (Correct answer)

Correct answer: Loss of impartiality and trust

Bias undermines the fairness and credibility of the review process and violates ethical standards.

Question 8: A federal contractor MRO receives a positive result for marijuana (THC) from an employee who holds a medical marijuana card in a state where medical marijuana is legal. The MRO should report the result as:

Dilute negative to reflect the mitigating circumstances
Cancelled, pending federal clarification
Positive, because federal law does not recognize marijuana as a legal substance regardless of state law (Correct answer)
Negative, because the employee has a valid state authorization

Correct answer: Positive, because federal law does not recognize marijuana as a legal substance regardless of state law

Marijuana remains a Schedule I controlled substance under federal law; state medical marijuana authorizations do not provide a valid medical explanation for federal workplace drug tests.

Question 9: Which cost component is typically EXCLUDED from a standard MRO review fee quoted to employers?

Direct communication with the donor
Laboratory specimen analysis fees (Correct answer)
Reporting results to the DER
Review of chain of custody documentation

Correct answer: Laboratory specimen analysis fees

Laboratory specimen analysis fees are billed separately by the laboratory and are not included in the MRO review fee.

Question 10: A donor tests positive for PCP. The donor claims they were exposed to PCP through passive inhalation at a party. How should the MRO respond?

Request the lab to perform additional confirmatory testing
Report negative if the donor provides a written statement
Cancel the test and request a hair follicle confirmation
Report positive because passive inhalation is not a scientifically accepted explanation for a PCP positive (Correct answer)

Correct answer: Report positive because passive inhalation is not a scientifically accepted explanation for a PCP positive

Passive inhalation is not a recognized scientific explanation for PCP positives at federally mandated cutoff levels.

Question 11: A federally regulated employer tests 200 safety-sensitive employees and has a DOT random rate of 25% for drugs. Assuming $55 per test (all-in), what is the projected annual random drug testing cost?

$11,000
$27,500
$2,750 (Correct answer)
$5,500

Correct answer: $2,750

25% of 200 employees = 50 random selections × $55 per test = $2,750 projected annual cost.

Question 12: Which of the following best defines 'MRO independence' as required by DOT Part 40?

The MRO may not be licensed in the same state as the employer
The MRO must operate a solo practice with no staff
The MRO must rotate among multiple employers every two years
The MRO must be free from employer and laboratory influence in making verification decisions (Correct answer)

Correct answer: The MRO must be free from employer and laboratory influence in making verification decisions

MRO independence means that verification decisions must be made based on medical and scientific evidence, free from external pressure by the employer or laboratory.

Question 13: Which federal agency sets the guidelines for workplace drug testing?

NIH
DEA
SAMHSA (Correct answer)
OSHA

Correct answer: SAMHSA

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the standards and protocols for drug testing procedures.

Question 14: A C/TPA selects employees for random testing from a consortium pool. Who is responsible for ensuring the selected employees are actually tested?

The MRO's office
The C/TPA solely
Each individual employer of the selected employees (Correct answer)
The collection site coordinator

Correct answer: Each individual employer of the selected employees

Each employer must ensure that their selected employees complete the random test in the designated timeframe; the C/TPA only performs the selection.

Question 15: Which of the following represents an appropriate use of trend data in an MRO quality assurance program?

Using positive rate trends to predict individual donor future test results
Using monthly invalid result trends to identify whether a specific laboratory's validity testing is drifting (Correct answer)
Using turnaround time trends to set donor interview appointment schedules
Sharing individual donor result histories with employer safety managers

Correct answer: Using monthly invalid result trends to identify whether a specific laboratory's validity testing is drifting

Trending invalid result rates by laboratory can reveal systematic drift in a laboratory's validity testing performance over time.

Question 16: An employer switches to a new consortium mid-year. Which action ensures the employee's pre-employment result remains accessible?

Transfer CCF and MRO verification records to the new consortium (Correct answer)
Retest the employee before enrollment in the new consortium
The prior result is voided upon consortium change
Request the DOT to maintain a central record of all prior results

Correct answer: Transfer CCF and MRO verification records to the new consortium

Transferring the CCF and MRO verification documentation to the new consortium maintains the employee's complete testing history without requiring retesting.

Question 17: If the primary specimen is reported as adulterated and the donor requests a split specimen retest, where is the split tested?

Any clinical lab approved by the employer
The split specimen is automatically discarded after an adulterated primary result
The same primary laboratory using a different analyst
A second HHS/SAMHSA-certified laboratory chosen by the MRO (Correct answer)

Correct answer: A second HHS/SAMHSA-certified laboratory chosen by the MRO

The split (Bottle B) must be sent to a different HHS-certified laboratory to ensure an independent review of the adulteration finding.

Question 18: How does risk management apply to daily practice in Source Selection & Evaluation for Medical Review Officer professionals?

Through proactive identification of potential hazards and implementation of preventive measures (Correct answer)
By avoiding high-risk situations entirely
Only through responding to incidents after they occur
Through annual safety audits exclusively

Correct answer: Through proactive identification of potential hazards and implementation of preventive measures

Effective risk management in Source Selection & Evaluation requires proactive hazard identification and preventive measures, not just reactive responses. This approach reduces incidents, improves outcomes, and protects both professionals and clients.

Question 19: Under 49 CFR Part 40, which of the following cutoff concentrations is correct for an initial marijuana (THCA) immunoassay screen?

15 ng/mL
25 ng/mL
100 ng/mL
50 ng/mL (Correct answer)

Correct answer: 50 ng/mL

The initial immunoassay screen cutoff for marijuana metabolites (THCA) is 50 ng/mL under current HHS guidelines.

Question 20: An employee tested positive for marijuana. They present the MRO with a valid state medical marijuana card. What should the MRO do?

Cancel the test and request a urine recollection
Defer the report until the employer reviews the card
Report the result as positive — federal law supersedes state law under DOT (Correct answer)
Verify the card and report the result as negative

Correct answer: Report the result as positive — federal law supersedes state law under DOT

Under DOT regulations, a state-issued medical marijuana card is not a valid medical explanation, and the MRO must report the result as positive.

Question 21: For DOT-regulated pre-employment testing, the cost of a cancelled test (e.g., due to a fatal flaw on the CCF) is typically borne by:

The collection site, which is liable for the flaw
The employer, who must arrange and pay for a recollection (Correct answer)
The MRO, who waives the review fee
The donor, who must pay for recollection

Correct answer: The employer, who must arrange and pay for a recollection

When a test is cancelled due to a fatal flaw, the employer must fund a new collection because the cancelled test cannot satisfy the testing requirement.

Question 22: An employee on federal safety-sensitive duty discloses to the MRO during a verification call that he is taking a prescribed narcotic that impairs his ability to safely perform his job. The MRO should:

Advise the employee to self-report to the employer and, if he refuses, contact the DER to discuss immediate safety concerns (Correct answer)
Take no action because the prescription is legal
Report the information directly to the employee's prescribing physician
File a complaint with the state pharmacy board

Correct answer: Advise the employee to self-report to the employer and, if he refuses, contact the DER to discuss immediate safety concerns

When an employee discloses an immediate safety risk, the MRO should encourage self-reporting and, if the employee refuses, may contact the DER to address the imminent safety concern.

Question 23: What is the primary purpose of the MRO's interview with a donor following a non-negative drug test result?

To conduct a physical examination and assess impairment
To inform the employer of the specific substance concentration detected
To determine whether a legitimate medical explanation accounts for the result (Correct answer)
To obtain a signed admission of drug use from the donor

Correct answer: To determine whether a legitimate medical explanation accounts for the result

The MRO interviews the donor to evaluate whether a legitimate medical explanation, such as a valid prescription, accounts for the non-negative laboratory result before reporting to the employer.

Question 24: An MRO contract renewal negotiation reveals the vendor has increased per-test fees by 30% due to lab cost increases. The existing contract contains an 'economic price adjustment' (EPA) clause. What does this clause typically allow?

The employer to immediately terminate without penalty
Fixed pricing for the entire contract term regardless of market changes
Automatic fee increases tied to a specified index or cost trigger (Correct answer)
Mandatory renegotiation of all contract terms simultaneously

Correct answer: Automatic fee increases tied to a specified index or cost trigger

EPA clauses permit price adjustments based on predefined indices or cost-change triggers, protecting both parties from extreme market fluctuations.

Question 25: What initial testing method is required for DOT federal workplace urine drug screening?

Gas chromatography/mass spectrometry (GC-MS)
Thin-layer chromatography
Immunoassay (Correct answer)
Liquid chromatography-tandem mass spectrometry (LC-MS/MS)

Correct answer: Immunoassay

Immunoassay is the required initial screening method for all federally mandated urine drug tests.

Question 26: Which of the following best describes the MRO's duty when an employee's result is challenged in litigation and a court subpoena is issued for test records?

Release records only to the employee's attorney
Comply with the subpoena but notify the employee before releasing records (Correct answer)
Destroy the records to protect employee privacy
Refuse to comply because DOT records are federally protected

Correct answer: Comply with the subpoena but notify the employee before releasing records

An MRO must comply with a valid court order or subpoena but should notify the employee prior to disclosure when feasible.

Question 27: How long must an MRO retain records of verified positive, adulterated, substituted, and cancelled test results under DOT regulations?

10 years from the date of the verified result
5 years from the date of the verified result (Correct answer)
2 years from the date of the verified result
1 year from the date of the verified result

Correct answer: 5 years from the date of the verified result

Per 49 CFR §40.333, MROs must retain records of verified positive, adulterated, substituted, and cancelled test results for a minimum of 5 years.

Question 28: Under DOT HHS criteria, a dilute specimen is defined by which creatinine and specific gravity values?

Creatinine 2–20 mg/dL and specific gravity 1.0010–1.0030 (Correct answer)
Creatinine less than 2 mg/dL and specific gravity less than 1.0010
Creatinine 20–50 mg/dL and specific gravity 1.0030–1.0100
Creatinine 10–30 mg/dL only

Correct answer: Creatinine 2–20 mg/dL and specific gravity 1.0010–1.0030

A dilute specimen has creatinine between 2 and 20 mg/dL with specific gravity between 1.0010 and 1.0030.

Question 29: Which standard of practice is MOST important for ensuring quality in Cost & Pricing Analysis?

Strictly adhering to the same procedure in every situation
Minimizing documentation to focus on practical work
Following evidence-based protocols while adapting to specific circumstances (Correct answer)
Using the most advanced technology available regardless of need

Correct answer: Following evidence-based protocols while adapting to specific circumstances

Evidence-based protocols provide a foundation of proven practices, but effective Medical Review Officer professionals must also adapt their approach based on specific circumstances and individual case needs within Cost & Pricing Analysis.

Question 30: What is the acceptable temperature range for a urine specimen when presented to the collector?

86–98°F (30–37°C)
90–100°F (32–38°C) (Correct answer)
98–106°F (37–41°C)
95–105°F (35–41°C)

Correct answer: 90–100°F (32–38°C)

A valid specimen must read between 90°F and 100°F on the temperature strip within 4 minutes of collection.

Medical Review Officer (MRO) Certification Exam

The MROCC MRO Certification Exam tests physicians on their knowledge of DOT drug and alcohol testing regulations, specimen collection procedures, laboratory analysis, and clinical interpretation required to serve as a Medical Review Officer in federally mandated workplace drug testing programs.

110

Questions

180 min

Time Limit

70%

To Pass

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