3 areas to target when preparing for CMS’s imaging appropriate use criteria

October 1, 2019 |  Government Regulations, Health IT

Close-up image of doctors hand pointing at x-ray resultsIf your organization is a Provider-Led Entity that orders advanced diagnostic imaging services for Medicare patients, preparing to meet requirements for imaging appropriate use criteria (IAUC) is likely to be high on your priority list. CMS expects a variety of outpatient settings, including physician offices and emergency departments, to begin educating staff and testing operations for AUC authorization as of January 1, 2020, with the goal of fully implementing the process by January 1, 2021.

When faced with meeting regulatory requirements, it’s easy to get lost in the details and wonder where to begin. Here are some areas providers should target when attempting to implement this process: 

1. Focus on the emergency department process before tackling the outpatient processes

Currently, the ED does not have to comply with medical necessity, so AUC authorization is a big change for ED providers. Therefore, establishing the best process within the ED first gives these providers more time to manage expectations, identify how meeting requirements will affect workflow for their staff, and determine how to find information on the claim. 

2. Engage your clinics when establishing the outpatient process

When you are ready to implement a process for your outpatient areas, be sure to work closely with the clinics exchanging information with you. Ensure they are aware of AUC requirements by sending them educational materials about it, and find out what they envision for their process. For example, will the AUC criteria be on the order they send over to you? If not, how do they plan to get that information to the outpatient sites performing the tests? It’s important that they establish a policy for handling orders before CMS performs AUC checks. 

3. Find a provider champion

Identifying a provider champion is important for helping other providers and staff to find value in the regulatory measure, or at the very least, to understand why it's required. Let your provider champion pilot the process. Once they are comfortable with it, open it up to a small group to continue the trial before turning it on for all providers. This approach will allow you to refine workflows and iron out any kinks, ensuring the project begins on a positive note. 

4. Test, test, test

Testing is very important! Be sure to test the speed and smoothness of transitioning through workflow screens when building the AUC checks that launch providers out to the National Decision Support Company (NDSC) or another certified decision support product. This testing will help you to identify gaps and streamline processes. Remember to touch base with outside vendors, especially if your organization uses outside radiologists to read films; they may want the AUC scores to flow over with the interfaced orders.

For more information, check out MEDITECH Senior Manager Rebecca Lancaster’s blog 3 Steps To Prepare for CMS’s Imaging Appropriate Use Criteria Guidelines. If you are a MEDITECH customer, you can also reference MEDITECH’s IAUC Resource page for additional information.

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Written by Kim Maples, IT Applications Manager, Carteret Health Care

Kim Maples is the IT applications manager at Carteret Health Care, where she manages the clinical and non-clinical analysts who support the electronic record and workflows. She currently serves on the MUSE Membership Committee and MEDITECH’s Nurse Advisory Committee.