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BY SUSAN GATEHOUSE, RHIT, CCS, CPC, AHIMA-APPROVED ICD-10/PCS TRAINER  The testing phase for the Appropriate Use Criteria (AUC) Program officially began January 1, 2020. Upon implementation of the program, physicians and other healthcare professionals who order an advanced diagnostic imaging test (MRI, CT, PET, and nuclear medicine; does not include X-rays, ultrasounds, or fluoroscopy services) must consult with AUC using a qualified decision support mechanism (CDSM). Professionals who provide these tests will be required to register the ordering professional’s consultation of AUC to be paid for the service. Providers will be required to use a qualified CDSM (certified as meeting Centers for Medicare & Medicaid Services/CMS requirements). If a provider does not follow AUC requirements and is discovered to have ordering patterns deemed as outliers, the law mandates that CMS require prior authorization. G-codes are needed for every advanced imaging service, and claims with multiple G-codes “shall be’’ accepted. Though 2020 is a testing period, and the program will not officially implement until January 1, 2021, this is a considerable change, and taking advantage of the testing period, while there is no impact on reimbursement, is crucial.
Axea’s CEO, Susan Gatehouse, took a deeper dive into the operational assessments required during this testing period, in a recently published article by ICD-10 Monitor-News. In the article, Susan outlines the various processes to address in order to sufficiently prepare for the implementation of AUC, which will require the involvement of multiple departments, such as IT, radiology, physician, and health information management (HIM), just to name a few. To access the complete article published by ICD-10 Monitor, Click Here. You can also LISTEN to Susan Gatehouse discuss AUC and report on the issue in the Talk-Ten-Tuesday broadcast from January 21 - Link Here to listen to the broadcast.
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