The Centers for Medicare and Medicaid Services (CMS) announced that the payment penalty phase of the appropriate use criteria (AUC) consultation mandate will not begin Jan. 1, 2023 nor the January 1 following the end of the COVID-19 public health emergency as planned. CMS states that it is “unable to forecast when the payment penalty phase will begin.”
The Protecting Access to Medicare Act of 2014 (PAMA) requires an AUC consult to be documented via a CMS-qualified clinical decision support mechanism (qCDSM) prior to ordering advanced diagnostic imaging for Medicare patients. Without a documented consult, rendering providers will not receive Medicare payment for the procedure once the penalty phase begins.
The ACR will continue to work with CMS to solve the logistical issues preventing full implementation of this important quality program that will ensure Medicare patients receive the right imaging at the right time. The resources below can help you and your referring providers prepare to comply with the AUC mandate.
Direct questions about the AUC program to PAMA-AUC@acr.org.