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NKCH Readies for Medicare’s Imaging CDS Requirements

External Portal for Non-Cerner Users

Physicians without access to Cerner PowerChart may use an external portal. They first must register their unique NPI. After establishing their user name and password, they will be taken to a CareSelect login page. After logging in, they may consult the CDS tool.

The AUC modifier and G code must be included on the Outpatient Order Form prior to faxing to NKCH Scheduling at 816.346.7150. (Direct questions to NKCH Scheduling at 816.691.5267.)

On Jan. 1, 2020, the Protecting Access to Medicare Act began requiring referring providers to consult appropriate use criteria when ordering advanced imaging services. In 2020, the program will operate in an education and testing mode, during which Medicare claims will not be denied for failing to include AUC consultation information.

Clinical Decision Support

High-tech imaging exam orders will trigger integrated CDS for:

  • Computed tomography
  • Magnetic resonance imaging
  • Nuclear medicine
  • Positron emission tomography

Instead of having to keep apprised of ever-changing AUC and practice guidelines, physicians can rely on the approved CDS tool embedded within Cerner (physicians without Cerner access, see box), which is based on input from the American College of Radiology.

“As it is now, when physicians order high-end tests, they go through a preauthorization process in order to get approval for patients to get exams,” said Medical Director of Radiology Services Roger R. Ivey, MD, a radiologist with Northland Radiology. “In essence, if CMS feels this new system is successful, it may eventually be able to replace the current preauthorization process for imaging studies by using an integrated AUC. If physicians can do this to the satisfaction of CMS, CMS could then pass its administrative cost savings back to physicians.”

Physicians must consult the CDS tool, which automatically accesses AUC to help make the most appropriate treatment decisions.

The CDS tool provides a determination of whether the order:

  • Adheres to appropriate use criteria
  • Does not adhere to appropriate use criteria
  • Does not fall within available appropriate use criteria in the CDS tool

Physicians can select “I can’t find a match” and add free text as the reason for an exam if they cannot find an appropriate reason within the provided list.

Physicians are not required to adhere to the CDS recommendation. The CDS tool provides point-of-care guidance and does not force or prevent decision-making. However, the radiologist and center performing the imaging may be at risk for denial of the claim beginning in 2021.

Learn More

Visit the NKCH CDS website for links to learn more about:

  • American College of Radiology CDS
  • CMS AUC program
  • CMS Medical Learning education and testing mode

Ease of Use

In early testing with emergency medicine physicians at NKCH, Dr. Ivey said they reported the CDS tool to be simple to navigate.

“There are many tests and variances of tests in radiology. It can be very confusing to know the best version of a particular test to order,” Dr. Ivey said. From my standpoint, this really is an evolution of the American College of Radiology’s published guidelines because the information is now displayed for physicians to select the most appropriate imaging studies.”

Roger R. Ivey, MD.

Roger Ivey, MDDr. Ivey earned his medical degree from the University of Missouri-Columbia. He completed his residency in radiology and fellowship in musculoskeletal radiology at the Nebraska College of Medicine.