April 29, 2020

ACR Urges CMS to Support Changes to PAMA and Mandatory AUC Use

The American College of Radiology® (ACR®) is urging Congress to amend the Protecting Access to Medicare Act (PAMA) of 2012 and its requirements for mandatory physician consultation with appropriateness use criteria (AUC) when ordering advanced diagnostic imaging for Medicare patients.

The ACR recognizes the Centers for Medicare and Medicaid Services (CMS) has encountered major challenges while implementing the law. The proposed changes would ease burdens on radiology and referring physician practices and would allow the program to be fully implemented in short order.

In a letter to CMS Administrator Seema Verma, the College urged the agency to express support to Congress for eliminating the real-time claims processing element in the AUC consultation program.

Instead, ordering providers would self-attest to the consultation, and the qualified clinical decision support mechanisms would collect the AUC consultation information (as is already required of the mechanism). This information would then be provided to CMS for retrospective review and annual audit.

The ACR also proposes amending the current language of PAMA to account for and exempt practices that qualify as a participant in an advanced alternative payment model in Medicare’s Quality Payment Program, as well as clinical practices that participate in clinical trials.

Questions about the PAMA-AUC mandate may be directed to the ACR by email at PAMA-AUC@acr.org.