CMS to Implement Appropriate Use Criteria for Advanced Imaging Services

The Centers for Medicare and Medicaid Services (CMS) will soon implement new imaging requirements through an Appropriate Use Criteria for Advanced Imaging Services to reduce inappropriate or incorrect imaging orders. CMS will begin to implement these criteria in 2020 as a voluntary compliance year and will require full compliance beginning in 2021. These criteria may significantly affect the imaging-servicing process at healthcare facilities that order or deliver imaging services, thereby affecting medical access professionals.

A few quick basics about this AUC:

• CMS is trying to curb inappropriate and/or incorrect imaging orders to help reach a diagnosis.
• To enforce these new stipulations, CMS will require the rendering provider to prove on the claim he/she submits that the ordering provider consulted a clinical-decision support system, which grades the effectiveness of the potentially ordered test, to determine if it’s the best test for that individual.
• The rendering provider would document this transaction by including a Decision Support Number on the claim.

Many questions and challenges are currently unanswered and this will undoubtedly only increase as the full implementation date gets closer. Many hospital groups have expressed concerns regarding the logistical feasibility of this requirement, and the burden it will have on the current system. 

NAHAM’s Policy Development and Government Relations Committee is working to provide the NAHAM membership education, resources, and support around this rule this year and next to ensure you are as equipped as possible to implement and facilitate this AUC. Visit the NAHAM website to find more information about AUC and the other issues the committee is tracking.  

Look for more information about educational webinars, guidance documents, and additional news from NAHAM’s Policy Development and Government Relations Committee within the coming months. As always, you’re welcome to contact the PD & GR Committee with questions or requests for more information by emailing Molly Giammarco, NAHAM’s Senior Manager for Government Relations.