The right exam for the right reason
The Hill Medical Corporation is here to assist in the implementation of CDS. In order to have minimal disruptions to work-flow and caregiver productivity, we have prepared various resources and information to guide clinicians during CDS implementation.
The CMS program was established to increase the appropriateness of the advanced diagnostic imaging services provided to Medicare beneficiaries by subjecting advanced imaging orders to Appropriate Use Criteria (AUC) tools. The Protecting Access to Medicare Act (PAMA) will require ordering/referring providers to consult Appropriate Use Criteria via a qualified Clinical Decision Support (CDS) mechanism prior to ordering advanced diagnostic imaging services for Medicare patients starting Jan. 1, 2020. The Hill Medical Corporation will be providing referring clinicians with a CDS tool and resources to assist with this new ordering process.
CDS will be required for most:
This program is a CMS work-in-progress, so more will be revealed over time. This is what we know now:
CMS Expectations and Incentives
Major exceptions to the requirements are studies performed on inpatients and emergency medical conditions requiring immediate medical attention. Medicare Advantage plans also are excluded from the requirement. We recommend that you frequently check the CMS website for updates.
Please email or leave us a voice message with the following information, and a representative will contact you within 48 hours.
1. EMR Vendor
2. Physician or Medical Group name
3. Your name and phone number
Thank you for your support as we all move towards value based healthcare.
Beginning January 1, 2023 CDS outliers will be identified, potentially affecting physician reimbursement and requiring pre-authorization for Medicare patients.
Source: CY 2019 Medicare Physician Fee Schedule
Using a clinical decision support (CDS) mechanism has the potential to reduce waste significantly, as in fewer delays in care and enhanced communication among physicians. CDS can significantly impact improvements in quality, safety, efficiency, and effectiveness of health care.
Seeing the value in CDS:
By employing these guidelines, providers enhance quality of care and contribute to the most efficacious use of radiology.
Hill Medical’s Radiologists and Technologists are available to help in the process. When you need direct answers to clinical questions about appropriate imaging use, we can help. The following situations may require further consultation:
If your EMR will not supply a CDS component, The Hill Medical Corporation will provide a free CDS portal for referring physicians. The portal will be made available later this year (2019).
CY 2016 Physician Fee Schedule (PFS) Final Rule with Comment Period CDS program
(pages 71102-71116 and pages 71380-71382)
CY 2017 PFS Final Rule Additional policies related to CDS program (pages 80403-80428 and 80554-80555)
CY 2018 PFS Final Rule Requirements for consulting and reporting under the Medicare AUC program
(pages 53187-53201 and page 53363)
Strategic Radiology has developed tools and resources to assist affiliated hospitals and members, like The Hill Medical Corporation to prepare for Clinical Decision Support (CDS) implementation. Strategic Radiology LLC (SR) is a nationwide membership organization of quality-focused, private radiology practices dedicated to performance improvement through data aggregation and sharing best practices. The organization represents 26 geographically dispersed, independent radiology practices that provide medical imaging services to more than 250 hospitals and 625 outpatient sites in about 40 states. The organization is wholly owned by its membership and governed by physician officers and physician Executive Committee members.
Strategic Radiology operates the only radiology-specific Patient Safety Organization listed by the Agency for Healthcare Research and Quality. Officially listed in 2013 by the AHRQ, the SR-PSO was recently re-listed.
Information presented was assembled in April 2019 based on current information from CMS, which is subject to change after publication. Clinicians should check the CMS website regularly for updates.