Starting January 1st 2020, documentation concerning the consultation of a Clinical Decision Support Mechanism (CDSM) is necessary for Medicare claims for advanced imaging tests (MRI, CT, PET and Nuclear Medicine).
January 1, 2020 begins a year long “operations and testing” period where there is no risk to payment if documentation is incorrect or missing. However, the testing period will be crucial to ironing out any kinks in the process before the program is fully implemented January 1, 2021 – the date when CMS will begin not paying claims lacking required documentation.
Communication between key players in the process is critical to compliance with the Appropriate Use Criteria/Clinical Decision Support (AUC/CDS) program, with Radiology practices bridging the gap between everyone involved.
Working with referring providers, facilities, EHR and CDSM vendors on how AUC documentation flows from point to point will be critical to beginning to test compliance with the program.
AUC/CDS documentation ultimately gets transmitted to CMS on Medicare claims using modifiers and G-codes. At a high-level, the modifiers and G-codes provide the following information: