Beginning January 1, 2020 when ordering and performing certain diagnostic imaging tests, providers must consult Appropriate Use Criteria (AUC) thorough a qualified clinical decision support mechanism (CDSM). In an effort to provide the most appropriate test to Medicare patients, CMS has implemented this criterion as a way to promote and validate medical necessity. Please note data gathered through AUC wil help CMS identify ordering providers who are outliers and order unnecessary tests on patients.
Don’t make the mistake of thinking that CDS only affects those practices that are actually performing and billing for the Medicare diagnostic imaging tests. As the practice ordering the test, you must consult Medicare’s Clinical Decision Support Mechanism (CDSM) tool to determine if your order adheres to the new guidelines.
Failing to correctly include Appropriate Use Criteria (AUC) with your diagnostic test order will mean the test will most likely not be performed. Also, you don’t want to be identified as an outlier by Medicare, because that means that you’ll be required to get any diagnostic imaging test you order pre-authorized (not a pleasant thought).
- Discuss the rationale for evidence based medicine
- Review the Mandatory vs. Voluntary timeframe
- Discuss appropriate use of Medicare G codes and modifiers
- Review which diagnostic tests fall under AUC
- Review the requirements for the ordering provider and performing provider
- Discuss who is authorized to consult the CDSM on behalf of the provider
Areas Covered in the Session:
- Rationale for AUC
- Reporting periods
- Ordering provider responsibilities
- Furnishing provider responsibilities
- Exceptions to AUC
- Qualified CDSM vendor list
- What items should be listed on the claim form
- G codes and proper assignment
- Modifiers and proper assignment
- Future reimbursement and prior authorization implications
|Other Related Webinars:|
- Physician Practice Managers
- Claim Processors
- Healthcare Providers
- Hospice Providers
- Other Personnel interested in knowing E/M rules and guidelines
About the Presenter:
Lee Williams has over 15 years HIM experience as a coding director, auditor, educator, trainer, practice manager and mentor. She is presently the Director of Coding Operations at a large oncology/hematology physician practice located in the southeast region. In this role, some of her responsibilities include physician and staff education, risk mitigation, outpatient CDI and managing remote coding personnel. Lee also provides consulting services via a small firm with clients to include the Centers for Disease Control and Prevention (CDC), the U.S. Consumer and Product Safety Commission (CPSC) and Industrial Economics, Inc.
Lee has been published in AAPC’s Healthcare Business Monthly (HBM) magazine numerous times with her most recent article entitled “Help Combat the Opioid Crisis by Following Guidelines and State Rules,” appearing in the Feb. 2018 publication. She is founder and the current president of the local AAPC Covington, GA chapter and currently serves on AAPC’s National Advisory Board representing Region 4. Lee is a national speaker and highly credentialed through the American Health Information Management Association (AHIMA), the Association of Clinical Documentation Improvement Specialists (ACDIS) and the American Academy of Professional Coders (AAPC). She holds a degree in Health Information Technology and is a certified coder, compliance officer and clinical documentation specialist.
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