In an effort to reduce the number of inappropriate advanced imaging exams, the Centers for for Medicare and Medicaid Services (CMS) plans to implement a new requirement for appropriate use criteria clinical decision support (AUC/CDS) software consultation documented on all radiology requests. These CDS systems are supposed to be in place and in use beginning Jan. 1, 2023.
CMS said after Jan. 1, 2023, claims submitted without compliance certificates from CDS will be rejected, or face a 15% payment reduction. This is a mandate written into the Protecting Access to Medicare Act of 2014 (PAMA)
The AUC/CDS mandate was a big topic of discussion at the Radiology Business Management Association (RBMA) 2022 meeting in late April. RBMA offered a session to provide a refresher on the AUC/CDS requirements and discussed methods to be prepared.
Lisa Mead PSO executive director, Strategic Radiology, spoke at the session. She reviewed the components of the AUC/CDS program mandated by PAMA, and the methods that can be utilized by practices to successfully coordinate hospitals and referring providers in program implementation. She addressed questions regarding the CDS mandate.