Starting January 1, 2020, Protecting Access to Medicare Act (PAMA) will require referring providers to consult Appropriate Use Criteria (AUC) using a Clinical Decision Support (CDS) tool when ordering advanced diagnostic imaging services — CT, MR, Nuclear Medicine and PET — for Medicare patients.
The AUC mandate, included in the Protecting Access to Medicare Act, requires all providers ordering advanced imaging exam to consult an approved CDS mechanism and relay the results of the consultation to the imaging facility.
Documentation of AUC consultation will be required for all Medicare advanced imaging orders (CT, MR, PET, Nuclear Medicine) after January 1, 2021, or those services will not be provided.
Decision support requirements have already been built into Epic so providers with Epic access will be directed to complete the exam selection criteria when placing an advanced imaging order for Medicare patients.
Providers outside of MultiCare who refer patients to MultiCare's Medical Imaging services should begin establishing processes and procedures to ensure this documentation is provided now.
There are a number of tools that can be used to access one of the approved clinical decision support mechanisms, including National Decision Support Company's open access CareSelect tool. You can learn more about this open access tool by reading their Frequently Asked Questions.
For more information on Medicare and Appropriate Use Criteria, please visit the Centers for Medicare and Medicaid website.