With the start of the Clinical Decision Support program right around the corner, practical implementation on how to comply with the mandate should be high priority on 2020’s New Year resolution list. January 1st officially begins the operational and testing period when ordering providers must consult appropriate use criteria, through the use of a CDSM (Clinical Decision Support Mechanism) tool, when ordering advanced imaging studies for Medicare part B beneficiaries. Radiologists are responsible for providing the documentation of this consultation, in the form of Modifiers and G-Codes, to Medicare when billing appropriate claims.
While payment is not at risk in 2020, in the case that documentation is missing or incorrect, the year will be critical for preparing for 2021 when CMS will start denying claims. Most in the industry are in some stage of preparation and are finding that there’s no one answer on how best to implement the CDS process. For insights on what to consider when choosing a CDS strategy and links to additional resources, please see our article Medicare’s CDS Program: One Size Does Not Fit All.
Kayley Jaquet
Manager of Regulatory Affairs