During the ADVOCATE webinar earlier this month, “Clinical Decision Support: Next Steps in Implementation”, we highlighted the importance of starting the conversation early with your facilities and referring provider offices regarding what they need to be doing to prepare for the start of the Medicare Appropriate Use Criteria program. The complete recorded webinar is available on our website Click here.

Effective January 1, 2020, PAMA requires referring providers to consult Appropriate Use Criteria (AUC) via a qualified Clinical Decision Support Mechanism (CDSM) prior to ordering advanced diagnostic imaging services including CT, MR, Nuclear Medicine, and PET.

To help our clients and “friends of ADVOCATE”, we want to highlight some of the critical questions you should be asking when speaking with your facilities and/or referring providers.

Questions for Facilities:
• What CDSM has been selected and is being (or will be) used?
• Is the CDSM integrated in the EHR?
• Has a process been implemented for outpatient settings? Emergency Department?
• How will AUC information (G-codes and modifiers once published) flow to the radiologist and then to their billing vendor?

Questions for Referring Providers:
• Are referring providers aware of the AUC program?
• Who is responsible for purchasing the CDSM? Has a decision been made?
• How will AUC information be communicated to the furnishing provider?
• Does the referring provider meet any of the significant hardship exclusion exceptions?

We strongly encourage everyone to start these conversations now! As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.

Best regards,
Kirk Reinitz, CPA