Radiology Appropriate Use Criteria Webinars | RadNet
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Congress has mandated that ordering providers show that they consulted appropriate use criteria (AUC) when ordering advanced imaging (MR, CT, PET, NM) for their Medicare patients. The Centers for Medicare & Medicaid Services (CMS) has established that 2020 will be an educational and testing period for the Medicare AUC program. 

RadNet will be ready to accept AUC information during the 2020 educational and testing period.

What’s the latest?

No Medicare claims for advanced imaging will be denied for lack of AUC information. But CMS is encouraging ordering and rendering providers to participate in the program by publishing the necessary G-codes and modifiers corresponding to an AUC consultaton:

1. G-Code

Indicates the qCDSM, such as NDSC’s CareSelect¹, that was consulted prior to placing the order.

2. Modifier

Indicates whether the order:
• adhered to AUC, did not adhere to AUC, or AUC was not applicable
• Lacked AUC consultation information
• Qualified for an exception

3. NPI

The national provider identifier of the ordering professional (the referrer).

GOOD TO KNOW

For the ordering provider’s edification, the qCDSM returns a score to indicate how closely the ordered exam corresponds to AUC. Depending on the qCDSM, that score is shown as a color (red, yellow, green), a number (1-9), or letter.

Any exceptions?

Ordering professionals are exempt from consulting and reporting AUC only under these circumstances:

  • Emergency services in life-threatening situations

  • Services for an inpatient for whom payment is made under Medicare Part A, or for Medicare Advantage payments

  • A hardship exception, such as natural disasters, no broadband internet, or EHR system failures.

What is RadNet's role?

RadNet's AUC team is ready to accept AUC information, if provided by ordering clinicians, for our 300+ imaging centers and for our hospital partnerships. Billing, services, and management will all be affected by this mandate. 

The RadNet AUC team understands and can address all aspects of the law. We stand ready to assist RadNet's referring physicians as they make adjustments to meet these new consultation requirements. 

† National Decision Support Company’s CareSelect is used here only as an example; CMS qualifies all Clinical Decision Support Mechanisms.

Webinars

Get the full scoop on AUC.

Presented by:
Michael R. Mabry
Director, Public Policy and Economic Analysis

Pre-recorded WebinarView
Monday, December 2 , 2019
EST: 9:00am–9:45am
PST: 6:00am–6:45am
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Monday, December 2 , 2019
EST: 3:00pm–3:45pm
PST: 12:00pm–12:45pm
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Tuesday, December 3, 2019
EST: 8:00pm–8:45pm
PST: 5:00pm–5:45pm
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Wednesday, December 4, 2019
EST: 9:00am–9:45am
PST: 6:00am–6:45am
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Wednesday, December 4, 2019
EST: 5:00pm–5:45pm
PST: 3:00pm–3:45pm
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Thursday, December 5, 2019
EST: 9:00am–9:45am
PST: 6:00am–6:45am
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Monday, December 9, 2019
EST: 8:00pm–8:45pm
PST: 5:00pm–5:45pm
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Tuesday, December 10, 2019
EST: 12:00pm–12:45pm
PST: 9:00am–9:45am
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Wednesday, December 11, 2019
EST: 12:00pm–12:45pm
PST: 9:00am–9:45am
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Thursday, December 12, 2019
EST: 9:00am–9:45am
PST: 6:00am–6:45am
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Thursday, December 12, 2019
EST: 8:00pm–8:45pm
PST: 5:00pm–5:45pm
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Frequently Asked Questions

What happens if I don’t provide AUC consultation information?

The "MH" modifier will be reported on a Medicare claim for an order without AUC consultation information.

What about non-advanced diagnostic exams? Do I need to consult AUC?

Ordering professionals are not required to consult AUC for non-advanced diagnostic exams. The PAMA legislation mandates that AUC be consulted for all advanced diagnostic imaging services.

When does all this start?

The educational and operations testing period for the CMS AUC program is scheduled to begin on January 1, 2020. During that testing period, advanced imaging claims will be paid whether or not they correctly include AUC consultation information, but all ordering and rendering providers are strongly encouraged to participate.

My EMR doesn’t have an interface to a qCDSM. What are my options?

RadNet offers a free portal that integrates a qCDSM that providers can use to consult AUC. Also, CMS has identified 22 qualified and preliminarily-qualified Clinical Decision Support Mechanisms. Click here for the current list of qCDSMs. Three of those qCDSMs offer a free online AUC tool.

What exactly has to be on a claim to Medicare?

Medicare claims must include the National Provider Identifier of the ordering provider, the qualified Clinical Decision Support Mechanism used by the ordering provider, and whether the ordered procedure adhered to the AUC.

Will reports be different as a result of AUC?

No. Radiology reports are unaffected by AUC, with no change in lexicon or approach.

Who is allowed to perform the qCDSM consultation?

The consultation can be performed by the ordering clinician or a delegate, under the clinician's direction, who has sufficient clinical knowledge, qCDSM expertise, and the means to communicate the AUC results to the ordering clinician. The AUC information (G-code and modifier) must accompany the order for the advanced diagnostic imaging study.

I don’t understand all the requirements. What should I do?

RadNet has all the resources you need. We are ready with education and outreach to help you gain the knowledge you need to comply with the mandate and feel comfortable with the changes. To read about AUC, you can also click here (detail) or here (infographic).