On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) proposed delaying the deadline for the mandatory use of appropriate use criteria (AUC) for advanced diagnostic imaging until at least January 1, 2023. The agency included this provision in its annual Medicare Physician Fee Schedule (PFS) proposed rule, along with numerous other policy changes for Medicare programs and payments in calendar year 2022.
This move answers widespread industry speculation as to whether CMS would again delay the program by pushing back the current January 2, 2022 deadline. (Previously, CMS had established a deadline of January 1, 2021.) Significantly, the proposal reveals that CMS made this decision as a result of the agency’s own lack readiness, stating “[t]he earliest that our claims processing system can begin screening claims using the AUC program claims processing edits for the payment penalty phase is October 2022” and “we believe the earliest practicable effective date for the AUC program claims processing edits and payment penalty phase is January 1, 2023.”
Given this language, it is extremely likely that the final rule expected later this year will finalize this delay and establish a new deadline of January 1, 2023, if not later. NextGen Healthcare is studying the proposal and will provide guidance to clients in the weeks ahead.
Ready to learn more?
Register for the next Health Reform Simplified webinar on August 19, 4:00 PM ET, as the NextGen Healthcare regulatory team takes a deep dive into the Medicare PFS proposed rule and what it means for healthcare providers.
In the meantime, read the CMS press release and fact sheet.