MedInformatix Launches Initiatives to Help Clients Meet Mandatory AUC Requirements
Health IT innovator MedInformatix has launched a series of outreach initiatives helping its radiology clients successfully address requirements of the federally mandated Appropriate Use Criteria (AUC) Program. The AUC program is a policy provision of the 2014 Protecting Access to Medicare Act aimed at increasing the rate of appropriate advanced diagnostic imaging services such as CT, PET, MRI and other radiology services provided to Medicare patients. The program impacts all health care providers who order advanced imaging services whether in a hospital, ambulatory, outpatient or independent testing facility; and whose claims are paid under the physician fee schedule or other relevant system.
As part of the AUC program, at the time a practitioner orders an advanced diagnostic imaging service for a Medicare beneficiary, they will be required to consult a qualified Clinical Decision Support Mechanism, or CDSM. CDSMs are electronic portals, like MedInformatix, through which AUC are accessed. The CDSM provides a determination of whether the order adheres to AUC and its claim can be successfully processed or does not and cannot be covered under the AUC.
The program has been operating on a voluntary basis for the past several years. Just this month it transitioned to a year-long period of “educational and operations testing” during which time claims will not be denied for failing to include proper AUC consultation. Once the program officially takes effect on January 1, 2021, Medicare claims for imaging services will be denied if AUC consultation information is not correctly reported on the claim.
According to Chris Bruns, Director of Products and Services at MedInformatix, AUC is among the latest government mandates in the ongoing transformation of healthcare delivery in the U.S. His team recently launched a series of hands-on workshops and webinars taking place over the coming months so radiology clients can learn, test and prepare for AUC in advance of its industry wide implementation early next year. The company is also facilitating engagement in MI Central, the online community hub where clients engage in peer-to-peer dialogue and interact with MedInformatix product development and technology teams to optimize use of the MedInformatix technology platform.
“Keeping up with industry requirements can be a daunting process, especially for the stand-alone radiology practices like many of those with whom we work,” says Bruns. “With AUC, enterprises not fully prepared risk having claims denied, causing unnecessary disruptions to their workflow and billing procedures. Our goal is to equip the MedInformatix client community with the tools and information they need now in order tobe fully prepared once the program kicks in in 2021.”
