Starting Jan. 1, 2020, The Protecting Access to Medicare Act (PAMA) requires referring providers to consult appropriate use criteria (AUC) via a qualified Clinical Decision Support Mechanism (CDSM) when ordering advanced imaging for Medicare beneficiaries. Furnishing facilities will need proof of that consult to get paid for those exams.
View the most recent American College of Radiology-Radiology Business Management Association webinar with information on the CDS requirements, how to implement CDS in your practice and how to interact now with your referring providers to meet the AUC mandate. Read the webinar Q+A. | Download the webinar slide deck.
The ACR has also created an “AUC Toolkit” — available front-and-center on the ACR Clinical Decision Support page to help you understand the requirements and educate referring providers on this process. A special section includes materials to educate non-physician advanced practice providers.
These items provide background information and what should be included with applicable Medicare orders starting January 1. CMS is expected to publish detailed claims processing information this summer. We will then provide additional information to send to your referring providers.
In the meantime, the CDS Support page on the ACR website contains a wealth of materials to educate yourself, your facility management and billing teams and your referring providers on the PAMA requirements.
Please email PAMA-AUC@acr.org with any questions.