What the new appropriate use criteria (AUC) means for your practice
Appropriate use criteria (AUC) is set to change the way providers order advanced diagnostic imaging services. The Centers for Medicare & Medicaid Services (CMS) implemented new AUC criteria for these services on Jan. 1. Do you know how the regulation will affect your practice?
Changes you can expect WITH AUC
The program requires Medicare Part B providers to use a Clinical Decision Support Mechanism (CDSM) to support their reasons for wanting to order advanced imaging services.
The CDSM is an interactive electronic tool often offered as part of an electronic health record (EHR). It shares AUC information and assists in determining appropriate treatment. Specifically, it “provides a determination of whether the order adheres to AUC, or if the AUC consulted was not applicable,” according to CMS.
Tests that now require consultation with the CDSM include:
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET)
After consulting the CDSM, providers ordering advanced imaging tests will need to give consultation information to the “furnishing professional,” or the provider conducting the imaging study.
An Education and Operations Testing Period began Jan. 1, 2020 to help providers gain experience meeting AUC without the risk of penalties. The test period will end Jan. 1, 2021, and providers will be required to comply with AUC to avoid claim denials thereafter.
“The purpose of the AUC program is to enable you to order the most appropriate test for your patient.”
The data from the AUC program will allow CMS to pinpoint outliers among providers who order advanced imaging studies. As a result of their ordering behavior, these outliers will have to comply with prior authorization requirements when ordering these tests in the future.