Clinical Decision Support

One-year Testing Period Will Help Providers Conform to New CMS Requirement

In adherence to the Centers for Medicare & Medicaid Services (CMS) Appropriate Use Criteria (AUC) program, Erlanger Health System will begin implementing a one-year educational and operations testing period beginning January 1, 2020. This period will provide you, the provider, as well as our team time to conform to the new CMS requirement that will begin January 1, 2021 for those under Medicare Part B.

When ordering advanced imaging services covered under the AUC program, ordering professionals will be required to consult a qualified Clinical Decision Support Mechanism (CDSM) to provide a determination of whether the order adheres to AUC, or if the AUC consulted, was not applicable.

Examples of services covered under the AUC program include:

• Computed Tomography
• Positron emission tomography
• Nuclear medicine
• Magnetic resonance imaging

Exceptions to the requirement include:

• The ordering professional having a significant hardship, such as
  • Insufficient Internet access
  • EHR or CDSM vendor issues
  • Extreme or uncontrollable circumstances
• Situations in which the patient has an emergency medical condition
• An applicable imaging service ordered for an inpatient and for which payment is made under Part A.

Please note there are new fields within the Outpatient Imaging Physician Order Form that you will need to complete prior to ordering imaging for patients with Medicare Part B.

Orders may be submitted two ways:

 Through Epic via the EpicCare Link

- OR -

Self-register for Open Access – https://openaccess.careselect.org/registration

The Centers for Medicare & Medicaid Services will begin rejecting claims, beginning January 1, 2021 that do not contain the AUC consultation code or misreport AUC information on non-imaging claims.