Appropriate Use Criteria Requirements – Imaging Claims

appropriate use criteria

3 Key Items You Need to Know About Advanced Diagnostic Imaging Claims

Currently, the requirement to use Appropriate Use Criteria (AUC) for advanced diagnostic imaging services is set to become effective January 1, 2018.  While CMS has proposed changes that will delay with requirement, there is still work that needs to be done. You will need to make decisions and initiate conversations with your software vendor to ensure that your organization will continue to receive payment on the Medicare Part B Advanced Diagnostic Imaging claims. With the use of evidence-based AUC, clinicians can select the imaging study that is most likely to improve health outcomes for patients based on their individual context.

Here are 3 key items to help you prepare for the AUC requirements at the top of the year:

  • What to know: When CMS released the 2018 Medicare Physician Fee Schedule (MPFS) proposed rule, it helped clarify the requirements for the creation of Clinical Decision Support (CDS) programs for imaging and guide compliant AUC consultations. Learn more about this rule update here.
  • What to do: Check with your software vendor to determine your system needs updates to support this functionality. In regards to MEDITECH, these changes are included in MEDITECH MU3 Priority packs that were delivered in March 2017 (a top off may also be needed). If you need assistance, you can contact your Account Manager/HCIS Coordinator. You can also visit MEDITECH’s Resources Center
  • What are the next steps: MEDITECH has partnered with CareSelect Imaging, developed by the National Decision Support Company (NDSC), to offer a solution that enables compliance with this important requirement. Contracting with NDSC does require additional costs and it’s the responsibility of each site to discuss what is required. To learn more, click here.

If you would like to comment on CMS’s proposed updates to this requirement you can reference: Media Release 07.13.2017