Starting Jan. 1, 2020, The Protecting Access to Medicare Act (PAMA) requires referring providers to consult appropriate use criteria (AUC) using a qualified clinical decision support mechanism prior to ordering advanced diagnostic imaging (MRI, CT, PET and nuclear medicine) for Medicare patients to optimize use of those imaging modalities.
The American College of Radiology (ACR®) has heard concerns from many members about the lack of awareness of the program among their referring providers.
As such, we created an “AUC Toolkit” to help you understand the requirements and educate referring providers on this process.
The first phase of the toolkit includes the following resources:
For your information regarding PAMA and the genesis of the AUC requirement:
- JACR “Memo from the Chair” Column on PAMA/AUC Requirements
- ACR Bulletin Article by Economics Commission Chair Ezequiel Silva, MD
For you to send to referring providers:
- Medicare Learning Network AUC for Advanced Diagnostic Imaging Fact Sheet
- Customizable Letter that You Can Send to Referring 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 physicians.
In the meantime, the Clinical Decision 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 e-mail PAMA-AUC@acr.org with any questions.