Beginning January 1, 2018, the Protecting Access to Medicare Act (PAMA) will require referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services – CT, MR, PET, and nuclear medicine exams – for Medicare patients.
Providers can access imaging AUC via stand-alone electronic clinical decision support (CDS) systems or CDS software embedded in a physician’s electronic health record (EHR). The American College of Radiology (ACR) anticipates providers documenting that they consulted AUC by entering a provider identifier likely to be called a “decision support number (DSN)” in the exam order.
Rendering providers – radiologist or otherwise – may not receive Medicare payment for an advanced imaging exam if the referring provider does not verify that imaging AUC were consulted, and the mandate states that ordering physicians cannot shift the requirement to consult the guidelines to radiologists.
Although we cannot perform AUC administrative duties for referring providers, we strongly encourage you to prepare for this mandate by becoming familiar with the available CDS options so that access to care is not adversely affected by the new requirement.
The ACR-developed CDS – ACR Select® (digital ACR Appropriateness Criteria®) is an available option that can be integrated into most common EHRs and is expected to meet PAMA requirements. ACR Select is also available as a free online portal. CMS will announce approved CDS systems by June 30th and we will send additional information at that time.
For additional information online:
As of May 8th 2017 we will no longer provide X-ray services at North State Imaging, 1702 Esplanade. North State Radiology will continue to provide all other services at the following outpatient facilities:
For questions call (530) 898-0504.
North State Radiology is pleased to announce that James Rodriguez has joined the group as its new Executive Director effective August 17th.
Jim is a recognized executive with an extensive record of leadership and in-depth knowledge of the business and financial issues facing today’s integrated healthcare delivery systems. After receiving a BS in Public Administration from the University of Arizona in 1979 and an MBA from the University of Northern Colorado in 1981, he started his career as Director of Business Services at Mercy General Hospital in Sacramento followed by a position as the Chief Financial Officer for Woodland Clinic Medical Group, the largest physician group in the Sacramento Valley. He then moved on to the Bay Area where he was an Administrator with California Pacific Medical Center and managed their outpatient operations on two campuses. Then he was recruited to be the COO in leading the expansion into Northern California by Mullikin Medical Enterprises, a 500 member physician medical group from Southern California. From there, he spent the next 11 years as President and CEO of Physicians Integrated Medical Group (PIMG), a 500 member physician IPA in San Francisco. In 2010 Jim lead PIMG in the successful merger with the elite Hill Physicians Medical Group a 3,500 physician member IPA. After the Hill Physicians merger, Jim accepted a position as VP of Product Growth and Development for Brown & Toland Physicians in San Francisco and assisted them in creating an employed medical group for primary care physicians. In addition, he is also the founder and senior partner of Blackhawk Management Group, which has provided healthcare consulting and management services since 1995.
Jim has spent much of his life in Northern California where he and his wife Lori enjoy spending time outdoors, traveling, and collecting artwork and antiques. “I am very pleased to have the opportunity to lead such a renowned and respected organization as North State Radiology,” says Mr. Rodriguez.
“We are truly excited to have someone of Jim’s caliber join our team,” says Kiran Singh, MD, President of North State Radiology. “His proven ability, experience, and leadership in the complex arena of California healthcare will be a great asset for North State Radiology and the local medical community.”
Countdown to ICD 10
North State Radiology is among the providers and hospitals across the nation working to prepare for the upcoming shift from ICD 9 Current Procedural Terminology (CPT) codes to the new ICD 10 CPT codes effective October of this year. You can check out the current countdown to ICD 10 on the Centers for Medicare Services (CMS) website.
How will ICD 10 affect patients? While patients might not directly see any immediate changes, there is expected to be a great improvement on patient outcome and public health tracking. It is also thought that ICD 10 will aid in decreasing errors in physician orders by adding much more detail, leaving less to be misinterpreted down the line.
Examples of the enhancements made to the ICD-10-CM code set:
- It enables reporting of laterality (right vs. left designations), reflecting the importance of which side of the body or limb (e.g., left arm, left kidney, left eye) is the subject of the evaluation.
- It restructures reporting of obstetric diagnoses. In ICD-9-CM, the patient is classified by diagnosis in relation to the episode of care. In ICD-10-CM, the patient is classified by diagnosis in relation to the patient’s trimester of pregnancy.
Transitioning from ICD 9 to ICD 10 comes with many challenges and a wide learning curve. To help ease the impact on local physicians and medical offices, we will be hosting a an educational session for coders, office staff and providers. The sessions will be held from August 19th to the 23rd in Chico. Local offices can contact us to learn more about registering for the event, or use the code on their invitation to register via Eventbrite.
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