Protecting Access to Medicare Act (PAMA)
Appropriate Use Fact Sheet
CMS explains more about appropriate use criteria for advanced diagnostic imaging.
Changes to Referring Process for Advanced Diagnostic Imaging
Medicare regulations are changing – here’s what you need to know.
What is changing?
All advanced diagnostic imaging referrals ordered for patients covered by Medicare on or after January 1, 2020, will require consultation of Appropriate Use Criteria (AUC) through a qualified Clinical Decision Support Mechanism (qCDSM).
New Hanover Regional Medical Center will begin requiring CDSM consultation for these referrals prior to the CMS deadline, with the goal of helping all practices and referring providers achieve compliance with these new regulations.
What will the Clinical Decision Support Mechanism tell me?
The CDSM will provide information regarding appropriate use for advanced diagnostic imaging studies for certain diagnoses as determined by CMS. The tool will provide an identification number with each consult as well as one of the following status statements:
- Not appropriate
- Not applicable
Providers will be required to include both the identification number and status for each referral.
How can I access a Clinical Decision Support Mechanism?
NHRMC Medical Staff and clinical staff members will have access to an approved CDSM tool through Epic. Providers and practices who are not connected to NHRMC’s Epic electronic medical record will need to gain access to a CDSM tool either through their own electronic medical record system (if that option is available) or through another qualified CDSM tool. NHRMC is in the process of developing a tool that will be available to non-Epic users to maintain compliance with CMS regulations.
What tests are considered "advanced diagnostic imaging?"
Advanced diagnostic imaging tests that will require consultation with a CDSM include:
- CT scans
- PET scans
- Nuclear medicine studies
Only those studies performed in an outpatient setting require consultation with a CDSM.
Who can complete the consultation?
Consultation with a CDSM can be performed by most clinical staff under the direction of the ordering provider.
For additional information about the Protecting Access to Medicare Act, email PAMA@nhrmc.org, call 910-667-8290 or fill out the form below to contact a member of our team.