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: