Clinical Decision Support
The Protecting Access to Medicare Act (PAMA) has established a new program to increase the rate of appropriate advanced diagnostic imaging services, which mandates that all providers use Clinical Decision Support (CDS) tools when ordering outpatient CT, MR, Nuclear Medicine and PET-CT, for Medicare patients from January 2020.
Beginning on Jan. 1, 2020, Ordering Clinicians must consult Appropriate Use Criteria (AUC) when ordering outpatient advanced imaging (CT, MRI, PET, and Nuclear Medicine)
Furnishing Clinicians (i.e. radiologists) must document this consultation on both professional and technical claims for Medicare fee-for-service beneficiaries.
2020 is deemed an “Educational and Testing” period, and claims will be paid regardless of documentation. However, beginning January 1, 2021, Medicare will deny claims that do not include necessary information.
CareSelect is our qualified Clinical Decision Support Mechanism (CDSM), provided by National Decision Support Company (NDSC).
Please review the “CDS Presentation”, and share with your colleagues at conferences, tumor boards, to support awareness and education of the upcoming mandate. The presentation, along with other helpful materials, can be found on the left hand side of this webpage.
For additional information, please review the Centers for Medicare and Medicaid (CMS) website about the Appropriate Use Criteria Program.
Links
- Clinical Decision Support (CDS) PAMA update video (Password Protected: Please email ydr.editor@yale.edu if you need the password)
- Clinical Decision Support Memo
- Clinical Decision Support Presentation
- CDS Poster
- CMS - CDS – Appropriate Use Criteria