Are you prepared to participate in the Appropriate Use Criteria program that has formally begun?
The Appropriate Use Criteria (AUC) program as part of the Protecting Access to Medicare Act (PAMA) has officially started as of January 1, 2020. As part of this program, ordering providers are required to consult AUC for all Medicare Part B advanced diagnostic imaging services (CT, MR, PET, and Nuclear Medicine).
Both healthcare providers in physician offices and diagnostic testing facilities are affected by this regulation. CMS designates calendar year 2020 as an “Educational and Operations Testing Period” during which:
• Ordering providers supply AUC consultation details on all advanced imaging orders; and
• Performing providers (i.e., radiologists and imaging centers) begin to report these details on claims.
Staring January 1, 2021, AUC consultation details must be added to diagnostic service claims to avoid rejections or payment reductions.
Prepare your Practice and your Providers now
NextGen® Enterprise EHR supported AUC consultation starting with the 5.9/8.4 release in the Fall of 2017. All subsequent releases include working AUC functionality, with improvements made in each release. Starting with the next release of NextGen® Enterprise (Q1 2020), the AUC coding needed for claims reporting by the diagnostic performing facilities is automated.
All ordering providers should begin implementing AUC into their advanced imaging orders process and letting their diagnostic imaging partners know where to find this information, whether on faxed or transmitted HL7 orders. NextGen® Healthcare encourages clients to upgrade to the upcoming version of NextGen® Enterprise in order to have full support for AUC, including integration with HL7 interfaces, additional specialty workflows, and the first phase of claims automation.
For More Information
Visit the Advanced Diagnostic Imaging AUC Hot Topic page to learn more about the regulation and EHR workflows.