Starting Jan. 1, 2020, the Protecting Access to Medicare Act (PAMA) requires referring providers to consult appropriate use criteria (AUC) via a CMS-qualified clinical decision support mechanism (qCDSM) prior to ordering CT, MR, Nuclear Medicine and PET exams for Medicare patients.
2020 will serve as a one-year “Educational and Operations” testing period - with no Medicare penalties to rendering physicians for incorrect reporting or failure to report AUC consultation information on claims for advanced diagnostic imaging services.
As of now, starting Jan. 1, 2021, rendering providers will not receive Medicare technical or professional component payment for the procedure without a correctly documented AUC consult.
ACR Clinical Decision Support Resources are here to help you and your referring providers comply with the AUC mandate. Materials include:
- PAMA-AUC Toolkit
- Background Materials
- Tips and FAQs
Don’t wait until the New Year.