January 1, 2020, marked the start of the implementation phase for changes to Clinical Decision Support. The new mandate for Medicare and Medicaid patients requires referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services (ADIS) including CT, MRI, Nuclear Medicine, and PET.
Radiologic Associates of Fredericksburg has worked proactively with Mary Washington Healthcare to ensure that all referring physicians have the qualified Clinical Decision Support Mechanism (qCDSM) in place to accommodate the new requirements.
Under the Protecting Access to Medicare Act (PAMA), ordering providers are not mandated to strictly adhere to the AUC, just consult AUC. Unlike prior authorization, there is no “hard stop” to the ordering process. This requirement is being highlighted to ensure the implementation process goes smoothly, and patients continue to receive the best quality care.
Here’s what you can expect:
An AUC consult via a Centers for Medicare and Medicaid Services qCDSM must be documented.
Better outcomes and faster diagnoses can be achieved when evidence-based medicine and best practices are applied to imaging studies.
Some electronic health record (EHR) systems, including Epic, are integrating Clinical Decision Support systems into the workflow. Contact your EHR vendor to inquire about features that may be available.
Radiology departments and centers are required to report which qCDSM was consulted, the results of the consultation (adhere, not adhere, or not applicable), and the tax identification number (TIN) of the referring physician.
In order to avoid unnecessary delays in patient care, Radiologic Associates of Fredericksburg and Mary Washington Healthcare have jointly reached out to ordering physicians to explain the new requirements and provide resources.
Radiologic Associates of Fredericksburg wishes to be an ongoing resource for physicians during the implementation process. Further information can be found on the American College of Radiology website at acr.org