Appropriate Use Criteria (AUC) Updates

August 11, 2020 - On August 10, the Centers for Medicare and Medicaid Services (CMS) issued the following notification on the Appropriate Use Criteria Program web page to extend the education and testing period through 2021:

NOTICE: The EDUCATIONAL AND OPERATIONS TESTING PERIOD for the AUC Program has been extended through CY 2021. There are no payment consequences associated with the AUC program during CY 2020 and CY 2021. We encourage stakeholders to use this period to learn, test and prepare for the AUC program.

National Decision Support Company (NDSC) AUC Developments

In collaboration with NDSC, MEDITECH has been closely monitoring AUC developments and coded changes needed to support the announced claims requirements.

April 1, 2020 Coding Updates

Timelines were established to ensure the new coding changes are available prior to the new values being required on claims by January 1, 2021. The AUC Claims requirement changes will be included in the July priority pack. Updates for customers are in the process of being scheduled. If you have not yet scheduled your update, please reach out to your Account Manager.

The Claims Requirement code changes include the following:

• The G-Code G1004 for the NDSC vendor is automatically applied to orders where the AUC check is completed through the integrated solution.
• Adherence modifiers are automatically applied to orders where the AUC check is completed through the integrated solution.
• Scores of 4 through 9 receive the ME modifier as “adheres to appropriate use criteria.”
• Scores of 1 through 3 receive the MF modifier as “does not adhere to appropriate use criteria.”
• If the clinical decision support mechanism does not have appropriate use criteria for a specific order, the MG modifier is applied.
• A new field was added to the MIS AUC Dictionary/Parameters called ED Priority Exceptions where organizations specify ED priorities that are exempt from AUC checking.
• Orders placed on patients with the specified priorities do not launch AUC and the MA modifier is applied to the order. 
• A new field was added to the MIS AUC Dictionary/Parameters called Extreme Circumstances Bypass AUC Facility. 
• This facility-specific setting can be enabled by organizations to allow a temporary bypass of AUC checking, and the MD modifier is applied to all eligible orders until the facility is removed from the field. 
• The manual entry screen was enhanced to accept the vendor g-code and modifier. In addition, two new query fields were added to the AUC Dictionary/Parameters to allow organizations to map group response queries for the manual entry process so users can select from a list of g-codes for various vendors as well as select the applicable modifier. 

Efforts are underway to provide complete workflow and build documentation detailing all new changes and will be posted to the Imaging Appropriate Use Criteria Resource Center.

Please refer to this CMS AUC resource.

Questions

Please email our Regulatory Mailbox.