Effective January 2017, Medicare will require providers to consult physician-developed Appropriate Use Criteria (AUC) and formally document their consultation prior to ordering a diagnostic imaging test. Although the burden of proof falls on the referring physician, it will also impact payment to the imaging physician if they are not one in the same.
The changes are designed to:
- Encourage evidence-based medicine
- Ensure indicated tests are performed on the appropriate patients
- Avoid duplication and reduce costs
- Use healthcare resources more efficiently
- Create greater patient outcomes
The specific AUC guidelines are due to be released by Centers for Medicare and Medicaid Service (CMS) no later than November 2015. Clinical decision-support tools designed to help navigate AUC are to be identified by Health and Human Services (HHS) by April 1, 2016. However, exactly how the process of documentation will be implemented into daily practice remains to be seen. For more information on the on the upcoming changes, here are some additional resources:
Understanding Appropriate Use Criteria in Nuclear Medicine
ACCF/ASNC Appropriateness Criteria
CMS to Require Appropriate Use Criteria Consultation
New Law Mandates Use of Imaging Appropriateness Criteria
