Appropriate Use Criteria (AUC) and What it Means For You and Your Patients
Written by John Steuter, MD
By now you have probably heard the term “Appropriate Use Criteria” or “AUC” and with the January 1, 2020 Education and Operations Testing Period start date right around the corner, you may be asking yourself, what does this mean for me and/or my practice?
Chances are you most likely will need to modify a few things on your end.
The push behind utilization of Appropriate Use Criteria (AUC) is a result of a mandate from the Centers of Medicare and Medicaid Services (CMS). It requires AUC information to be included for advanced imaging exams completed in cardiology and radiology – specifically Computed Tomography (CT), Positron Emission Tomography (PET), Nuclear Medicine and Magnetic Resonance Imaging (MRI).
What is AUC and how is AUC information obtained?
AUC is a program to validate the necessity and clinical appropriateness of advanced imaging exams. This is new information ordering providers are required to provide before the patient receives the exam.
Per CMS regulations, the performing facility cannot obtain the AUC information. It is the responsibility of the ordering provider (physician or APP) or clinical/non-clinical staff employed by the ordering provider to obtain the AUC information and provide this with the order for the exam.
The AUC information is obtained through a qualified Clinical Decision Support Mechanism (CDSM). There are two ways provider offices can obtain the required AUC information:
- Check to see if your practice’s electronic medical record (EMR) system has functionality to integrate access to the government website. If you are unsure if your EMR will provide this functionality, contact your practice’s local IT support team or the EMR vendor.
- There are multiple CDSM websites you can use to obtain AUC information.
Important upcoming change to the ordering process for advanced imaging exams (CT, PET, Nuclear Medicine and MRI tests).
Effective January 1, 2020 there will be a change for providers ordering advanced imaging exams. The change will apply to outpatient and non-emergent Emergency Department orders for these exams at all facilities including hospitals, free standing surgical centers and independent diagnostic testing facilities that provide advanced diagnostic imaging services. This change is the result of a mandate from the Centers for Medicare and Medicaid Services (CMS) that requires Appropriate Use Criteria (AUC) information be included for advanced imaging exams completed in cardiology and radiology.
Q: What is the effective date the AUC information will be required?
A: Starting January 1, 2020 for advanced imaging exams scheduled at Bryan.
Q: My clinic is very busy, I don’t have time to log into another site to get a code. Can Bryan provide the code?
A: Per CMS regulations, only the ordering provider (physician or APP) or clinical/non-clinical staff employed by the ordering provider can complete the CDSM process in either the practice EMR or a third party clinical decision support website.
Q: What if I don’t include the AUC information when I send over the outpatient exam order?
A: Patients may be scheduled for advanced imaging exams prior to sending the order but these exams cannot be performed until a complete signed order is received, including AUC information. Staff from the Bryan Scheduling and Patient Service Center will call the office and request a new order including the AUC information.
Q. What if the request is emergent?
A. For all outpatients, even if the advanced imaging exam is emergent, the AUC information will be required.