One of the cornerstones of the Protecting Access to Medicare Act of 2014 was the development of an appropriate use criteria (AUC) program that requires doctors to consult a qualified clinical decision support mechanism (qCDSM) when ordering advanced imaging services for Medicare patients. As many in the revenue cycle management (RCM) world already know, CMS was scheduled to start penalizing providers who don’t participate in the AUC program on Jan. 1, 2022. The COVID-19 pandemic, however, led to such actions being delayed until 2023 at the earliest.
The latest CMS data suggest that preparation for AUC has been slow going for many healthcare providers. Consider, for example, that just 9% of CY2020 claims subject to AUC policies were submitted with enough relevant data. The delay in AUC penalties represents a significant opportunity for providers to integrate, educate and test AUC workflows to ensure as little disruption as possible takes place when the payment penalty phase officially (eventually) goes into effect.