The start of the CMS Appropriate Use Criteria (AUC) program is rapidly approaching. Beginning January 1, 2022, an AUC consults prior to ordering advanced diagnostic imaging for Medicare patients must be documented via a CMS qualified clinical decision support mechanism QCDSM. Without a documented consult, rendering providers will not receive Medicare payment for the procedure. To prepare for the start of the program, rendering providers and facilities need to focus on partnering with a CMS-approved QCDSM to ensure they continue to receive payment for performing the imaging procedure.  

In this article, we will go over six different aspects these organizations need to keep in mind when it comes to choosing the right qCDSM partner.

1. Partner With a Technologically Robust QCDSM

Partnering with a CMS qualified clinical decision support mechanism QCDSM that is cloud-supported and harnesses the power of artificial intelligence allows care providers to make the best decisions in the most efficient way. Key aspects like a user-friendly design and a seamless EHR integration are just a few features that can make the difference between ordering providers utilizing the system or not.

2. Value for Quality

A partner that offers a balance between significant ROI and cost is paramount to easing the financial burden that may occur throughout the year. Look for solutions with easy implementation, the minimal interruption to workflow, and robust AI algorithms to allow organizations to reap the benefits of CMS compliance. If a solution is low cost but is disruptive to ordering providers’ workflow and difficult to use, the cost will not matter.

3. Clean User Interface

Probably one of the most important things to look for in a qCDSM is to have a user-friendly UI. The reason for this is simple: ordering physicians are more likely to provide an AUC consult certificate that will be used for end-of-the-year CMS reimbursement purposes if the process is simple. Since ordering physicians are not reimbursed for taking the extra step in completing a questionnaire for an advanced diagnostic screening, getting them to complete this step needs to be as clean and quick as possible. 

4. Modular Use

Tools that can be pivoted across a variety of uses and functions help provide additional value and typically serve as the best qCDSM’s. They allow for pre-loaded patient data based on the MRN (a medical record number) to be present within the database and immediately accessible and available with just a click of a button to ordering providers, care managers, and radiologists.

5. EHR Integration + Independence

A modular CMS qualified clinical decision support mechanism QCDSM that is part of a greater patient application can be integrated right into the EHR. From here, the patient information can be pulled and saved into the EHR for the AUC consultation certificate that is sent to the imaging facility. If the provider setting doesn’t have an EHR, the qCDSM should be able to operate without patient information already loaded. In this case, all the provider needs to do is fill out the patient information and save it into their own independent system.

6. Seamless Coordination Between Providers

Intuitively designed solutions allow for enhanced collaborative workflows between ordering physicians and image furnishing facilities. This results in a net benefit to the patient when the provider can easily submit an AUC consultation certificate and the imaging facility can get started on the diagnostic testing.

As the new CMS AUC rules are rapidly approaching, it will become increasingly important for radiologists to work with CMS-approved qCDSM’s. Working with a tool that can seamlessly integrate into care provider workflows as well as provide quick access to patient information will be paramount for radiologists to capitalize on CMS benefits in the coming year.

To learn more about how Persivia can help position your organization for AUC success, contact us to schedule a demo.