Clinical Decision Support

The Protecting Access to Medicare Act of 2014 (PAMA) requires that physicians or assigned staff who order outpatient advanced imaging scheduled for a date of service on or after January 1, 2023, must consult Appropriate Use Criteria (AUC) through a qualified Clinical Decision Support Mechanism (qCDSM).

Appropriate Use Criteria (AUC) is the criteria ordering clinicians need to consult through the qualified Clinical Decision Support Mechanism. AUC specifies when it is appropriate to perform a medical procedure or service. An “appropriate” procedure is one for which the expected health benefits exceed the expected health risks by a wide margin.

A qCDSM is a qualified interactive, electronic tool for clinicians that provides the user with Appropriate Use Criteria (AUC). This information is required to make the most patient-appropriate treatment decision for a specific clinical condition.

If use Epic to submit your order, you will automatically consult CareSelect, our preferred qCDSM.

If you use an EMR system to submit/fax orders, you will need to consult one of the qCDSM providers listed on the Centers for Medicare & Medicaid Services website.

While AUC applies to traditional Medicare Part B patients having advanced imaging exams, BJC HealthCare will require consultation via qCDSM for all payers.

Advanced imaging services are computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and nuclear medicine.

No. The mandate states that the ordering professional (or clinical staff under direction of the ordering professional) must collect the AUC.

Ordering providers with high rates of non-adherence may be subject to additional prior authorization requirements.

Questions?

For more information, visit Centers for Medicare & Medicaid Services or email PatientCare@mir.wustl.edu.