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临床决策支持

The Protecting Access to Medicare Act (PAMA) requires referring providers to consult Appropriate Use Criteria (AUC) before ordering advanced diagnostic imaging services such as CT, MR, 核医学 and PET - for Medicare patients.

The AUC program mandates that when ordering advanced imaging services, the referring provider must consult a 临床决策支持 Mechanism (CDSM). The referring provider must provide the appropriate documentation to the imaging facility so that the AUC consultation information is reported 关于医疗保险索赔.

The implementation date for 临床决策支持 (CDS) is January 1, 2023, however, the Centers for Medicare and Medicaid Services has implemented 2022年剩下的时间是测试期.

Referring providers that order advanced diagnostic imaging services for Medicare patients must use a qualified 临床决策支持 Mechanism (CDSM)向AUC咨询. 大西洋医学影像公司与 蔓越莓峰(G1008) 提供转诊医生进入 ezCDS,一个交互式的,易于使用的CSM.

ezCDS将:

  1. Check appropriateness for an imaging study and assign a modifier.
  2. Identify the appropriate imaging study based on the indications you provide.

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常见问题

  • What is a 临床决策支持 Mechanism (CDSM)?
    A 临床决策支持 Mechanism (CDSM) is an interactive, electronic tool for use by clinicians that communicates appropriate use criteria information to the user and assists them in making the most appropriate treatment decision for a patient’s specific condition.
  • 我如何进入电子档案系统?
    要进入电子结算系统入门网站, 点击这里. 亚洲beT356体育下载下载将提供您的登录凭据.
  • Can 亚洲beT356体育下载下载 access the 临床决策支持 Mechanism on behalf of referring provider?

    No, the Appropriate Use Criteria consultation must be performed by the referring provider’s office.

  • If my patient has Medicare Part B or Railroad Medicare as a secondary insurance, 我是否需要查阅适当使用准则?

    是的, referring providers must consult Appropriate Use Criteria for patients with Medicare Part B and Railroad Medicare listed as secondary insurance.

  • Do all medical providers have to participate with 临床决策支持?

    是的, all medical providers that order imaging exams for patients that have Medicare Part B or Railroad Medicare as either primary or secondary insurance must comply with the AUC Mandate unless they qualify for a hardship. 困难在于:互联网接入不足, electronic Medical Records or CDSM issues or extreme and uncontrollable circumstances.

  • What advanced imaging exams does the Appropriate Use Criteria Mandate apply to in an office setting?

    All CT and 核磁共振成像 exams ordered by a medical provider for patients that have primary or secondary Medicare Part B and Railroad Medicare insurance.

  • Do Medicare Advantage Plans have to comply with the Appropriate Use Criteria /临床决策支持 mandate?

    No, the mandate does not apply to Senior Managed Insurance Plans.

  • Will you provide services to my Medicare Part B and Railroad Medicare patients if the Appropriate Use Criteria information is no

    No, 亚洲beT356体育下载下载 will not be able to accommodate Medicare Part B and Railroad Medicare referred patients without the proper AUC documentation, as stated in the Appropriate Use Criteria Mandate.

  • What information will the ezCDS 临床决策支持 Mechanism ask for?

    You will need to provide information about the patient’s encounter including the test being ordered and the clinical indications and symptoms. Based on what is entered, an appropriateness score will be generated.

  • How will the qualified 临床决策支持 Mechanism information get communicated 亚洲beT356体育下载下载?

    The referring provider is responsible for providing the Appropriate Use Criteria consultation information to 亚洲beT356体育下载下载 as part of the electronic order or manually writing it on the patient’s script.

  • What information will the referring provider need to provide to 亚洲beT356体育下载下载?

    The referring provider will need to provide the 刀位点 for the 临床决策支持 Mechanism used (Cranberry Peak – G1008) and Modifier for whether the result of the consultation was “ad在这里”, “不坚持”, 或者“不适用”.

    点击这里查看修饰符列表

  • Can 亚洲beT356体育下载下载 to look up AUC consultation information if the referring provider forgot to provide it on the referral slip?

    是的, 亚洲beT356体育下载下载 has access to the list of CDS consultations, including referring provider info (e.g. 名称、新产品导入(NPI)、已订购的影像学研究和日期/时间. In addition, each consultation has a unique identifier. 如果您有可用的唯一标识符, 亚洲beT356体育下载下载 can look up all the details for that particular CDS consultation, 包括修改器, 刀位点.

  • Is t在这里 a cost to use the ezCDS Qualified Decision Support Mechanism?

    不需要,转介提供者不需要付费.

  • W在这里 can I find more information about 临床决策支持?

    请访问 www.acr.org/cds 了解更多信息.

  • 如果我有任何问题,我可以联系亚洲beT356体育下载下载的谁?

    Please contact your 亚洲beT356体育下载下载 Provider Relations Representative with any questions or concerns that you may have or you can email marketing@aminj.以取得进一步协助。.