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Anthem Blue Cross contract still in effect

Our contract with Anthem Blue Cross remains in effect and patients can continue to be seen in-network at our outpatient centers – Chico Breast Care Center, North State Imaging, and North Valley Advanced Imaging. We continue to provide cost-effective outpatient imaging services to the entire community. Click here for more information.

Posted in News And Updates |

North State Interventional Radiology Closure

Due to continued changes in the healthcare environment and reductions in reimbursement, the North State Radiology Board of Directors has made the difficult decision to discontinue new patient services at our interventional radiology clinic, North State Interventional Radiology.

Effective immediately, we will no longer accept new patient referrals for interventional radiology only.  However, the clinic will remain open through August 31, 2018 for the purpose of providing follow-up care and treatment to existing patients.

Patients can choose to continue their care with another provider and can call North State Interventional Radiology at (530) 898-0520 to request copies of their records. They will need to complete an Authorization and Request for Release of Medical Records form which can be faxed to (530) 893-9761.

We will continue to provide all other radiology services – including ultrasound, breast imaging, MRI, CT, and PET – through our outpatient clinics Chico Breast Care Center, and North State Imaging.

Posted in News And Updates |

Update to Appropriate Use Criteria (AUC) Mandate

The AUC Mandate has been pushed back to January 1, 2020. On that date, 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, MRI, PET, and nuclear medicine exams – for Medicare patients.

As we move towards mandatory implementation of this rule, questions remain with regards to how an ordering physician will prove they consulted a qualified clinical decision support (CDS) mechanism prior to ordering advanced imaging, how will that proof be passed along to the imaging practice, and how will the CDS consultation be indicated on the Medicare claim form that will be submitted by the imaging center?

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) finally published some answers. Starting July 1, 2018, providers can use a new Healthcare Common Procedure Coding System (HCPCS) modifier (QQ) to indicate that CDS was consulted. Reporting is voluntary at this point, but we can anticipate that it will become mandatory once the CDS requirement is closer to being fully implemented in 2020.

Ordering physicians should begin to implement CDS consultation with their advanced imaging exams in anticipation of the mandatory requirement. This would be a good opportunity to begin testing the process of communicating about CDS and ensuring that all imaging orders that went through a CDS consultation reliably include the QQ modifier applied to the coding and billing stage.

Providers who have questions about how to use the QQ modifier should first review the MLN Matters (issue MM10481) that CMS posted on March 2, 2018. It covers the history of the CDS requirement, where to find a list of qualified CDS mechanisms, who will be subject to the CDS consultation requirement, the most common code families the requirement would apply to, exceptions to the rule, and more. The MLN Matters document also has a reminder about the additional things CMS will want reported once the requirement is scheduled to become mandatory on January 1, 2020. This includes the ordering practitioner’s National Provider Identification (NPI) and documenting which qualified CDS mechanism the ordering professional consulted. Guidance on how to report this on a claims form is not ready yet, but will need to be published before CDS becomes mandatory.

We will post updates as we receive them.

For additional information online:

Qualified Clinical Decision Support Mechanisms (CDSMs)

Posted in News And Updates |

AUC Mandate – Clinical Decision Support

AUC Mandate MedicareBeginning 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:

Posted in News And Updates |