Per the 2018 Quality Payment Program proposed rule, the new compliance deadline is January 1, 2019, to use appropriate use criteria (AUC) for advanced diagnostic imaging services. An educational and testing period begins January 1, 2018.
Beginning in 2019, Medicare will require medical staff ordering advanced diagnostic imaging exams (CT, MRI, and nuclear medicine including PET) to demonstrate consultation with an approved AUC as a condition for imaging provider reimbursement. All advanced imaging exams furnished and paid under Medicare Part B must show evidence of AUC consultation through a qualified clinical decision support mechanism (qCDSM) to make a claim payable.
However, CMS has proposed an “educational and operations testing period” of one year that begins January 1, 2018. This will be a voluntary reporting period. During this period, ordering professionals can consult AUC, and furnishing providers can report AUC consultation information on the claim, but CMS would continue to pay claims whether or not the correct information is included. This will allow organizations already equipped with a qCDSM to begin reporting and become acclimated with advanced diagnostic imaging service workflows that include AUC criteria in the claims submission.
NextGen Healthcare has partnered with National Decision Support Company to deliver a no-fee version of their CareSelect™ Imaging solution, known as ACR Select™ Basic. ACR Select Basic will be integrated with NextGen Ambulatory EHR starting with our 5.9 release. We recommend clients take advantage of the educational and operations testing period – 2018 – to incorporate AUC consultation criteria in claims that include advanced diagnostic imaging services.
Clients who are not on the 5.9 release by January 1, 2019, will have the ability to access the same CDS through the ACR Select™ web portal.
Further updates, information and FAQs will be available after the General Release (GR) of NextGen Ambulatory EHR/PM 5.9 NextGen Knowledge Base Model (NextGen KBM) 8.4. – “5.9/8.4.” We recommended clients incorporate the new AUC functionality in their NextGen Ambulatory EHR version 5.9 training plan.