Protecting Access to Medicare Act (PAMA)
Beginning Jan. 1, 2020, CMS began collecting data from advanced diagnostic imaging services orders. The following January, this data will be used to determine whether imaging services in 8 priority critical areas will be reimbursed:
- Coronary Artery Disease (suspected or diagnosed)
- Suspected Pulmonary Embolism
- Headache (traumatic and non-traumatic)
- Hip Pain
- Low Back Pain
- Shoulder Pain (to include suspected rotator cuff injury)
- Cancer of the Lung (primary or metastatic, suspected or diagnosed)
- Cervical or Neck Pain
To comply with this new requirement, all providers (regardless of organization) will be required to consult Appropriate Use Criteria (AUC) when ordering certain imaging and cardiology exams.
Consulting Appropriate Use Criteria
When ordering an advanced diagnostic imaging or nuclear cardiology exam, you will have the option to select a Reason for Exam from a pre-populated list or enter your own reason in a free text field. Based on your selection and entries, you may get a BPA (Best Practice Advisory) that launches providing you with a score from 1-9 and possible recommendations for other studies to be ordered.
If you receive a score of seven or higher, your order will be placed as usual. Scores of six or below will trigger an AUC recommendation for a more appropriate tests. Disregarding this recommendation may impact reimbursement in the future.
You will be able to consult the CareSelect Open Access Portal (this link will take you to a one-time registration page) to generate a score for your exam. Enter an indication for requested exam, which will generate a score. If you have access to eRecord, you will not need to consult the portal. For more information on using the portal, please view the CareSelect Imaging Open Access User Guide. View the University Patient Requisition Forms.