The Centers for Medicaid and Medicare Services (CMS) has proposed suspending a Medicare program that requires the consultation of appropriate use criteria (AUC) when ordering outpatient advanced diagnostic imaging services. While many headlines suggest that AUC is no longer relevant, the American College of Radiology (ACR) believes that CMS still recognizes the value of AUC in improving utilization patterns for Medicare beneficiaries. The ACR supports the use of clinical decision support tools and hopes that the AUC program can still become viable and effective. However, CMS has faced challenges implementing the program and states that the real-time claims-based reporting requirement presents a barrier. The ACR's support for AUC is based on the desire to offer an alternative to pre-authorization for advanced imaging and ensure that Medicare patients receive the right tests at the right time.
Thu, 20 Jul 2023 12:29:50 GMT | Lexology