CMS pushes imaging appropriate use criteria go-live date back a year due to pandemic
The Centers for Medicare and Medicaid Services is delaying the go-live date for new imaging appropriate use criteria by a year, the agency announced on Monday.
CMS first kicked off the initial testing period for this program on Jan. 1, with full implementation slated for the same date in 2021. Industry advocates such as the Society of Nuclear Medicine and Molecular Imaging have advocated for a delay because of the pandemic and got their wish this week.
“There was significant concern that referring physicians and sites would not be ready for the implementation phase due to the COVID-19 public health emergency,” SNMMI advised its members on Tuesday. “Therefore, CMS announcing a one-year delay in the implementation phase (until Jan. 1, 2022) provides relief to the referring physicians and gives additional time to prepare for the implementation of this program.”
The appropriate-use requirement was first mandated under the Protecting Medicare and Medicaid Services Act of 2014, with the goal of curbing unnecessary care in the federal payment program. It stipulates that referring providers must consult an electronic clinical decision support system before ordering MRIs, CT scans or other expensive imaging tests for Medicare beneficiaries. And clinicians who over-order radiology services under this system will be labeled as “outliers,” with the feds eventually subjecting them to prior authorization, SNMMI noted.
Following Monday’s announcement, CMS will extend the testing period through Dec. 31, 2021. The agency chose not to address the appropriate-use mandate in its recently released physician fee schedule, which “means that the decision is final and not subject to comment,” the American College of Radiology wrote Tuesday.
CMS emphasized that it will not levy any imaging appropriate-use criteria penalties in calendar 2020 or 2021.
“We encourage stakeholders to use this period to learn, test and prepare for the AUC program,” the agency advised this week.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.