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    CMS Establishes First Component for the Medicare AUC Program

    November 05, 2015

    The Centers for Medicare & Medicaid Services (CMS) is laying out requirements for organizations that will develop appropriate use criteria (AUC). Last year, Congress mandated that physicians ordering advanced imaging procedures use AUCs in evaluating whether that procedure is necessary. We suspect that this mandate could be applied to many other procedures in the future. In 2017, those ordering advanced imaging tests must consult applicable AUC using a qualified Clinical Decision Support (CDS) tool and report the results of this consultation on Medicare claims.

     

    CMS defined the process for Provider-Led Entities (PLE) (including medical societies) to become qualified to develop, endorse, or modify AUC. A qualified PLE would be required to adhere to specified panel member composition, conflicts of interest disclosure, endorsement of other qualified PLE AUC, annual review, and the potential use of CMS Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) to assess wide variation between qualified PLE AUC. The qualification process begins in January 2016 and the list of qualified PLE will be posted June 2016. CMS deferred on defining criteria for a qualified CDS.

     

    Click here for the complete Final Rule.

     

    For questions pertaining to AUC-related changes and updates, please contact SCAI’s Director of Clinical Documents and Quality Initiatives, Joel Harder at jharder@scai.org.