Consult Decision Support for High Volume Images A mandate by Centers for Medicare and Medicaid Services called Protecting Access to Medicare Act (PAMA), requires all healthcare providers who order advanced imaging to consult appropriate use criteria through a qualified Clinical Decision Support Mechanism.
Northwestern Medicine has changed the date for requiring clinicians who place orders for high volume advanced images to consult clinical decision support tools. Starting in the spring, specific high volume advanced imaging orders -- such as PET, CT, MRI and nuclear medicine -- will trigger a best practice alert. You will receive a score from one to nine and possible recommendations for other studies to be ordered. Scores of six or below will generate a recommendation for more appropriate tests. If you receive a score of seven or higher, your order will be placed as usual.
Only 158 high volume image orders are impacted. X-Ray exams and ultrasounds are not included in the mandate.
CMS does not begin enforcing the mandate until January 1, 2022. However, NM is complying ahead of time to allow time for ordering clinicians to learn, practice and prepare for the new workflow without penalty.
How will this impact practices that do not use Epic NM will require clinical decision support (AUC) consultation information for select imaging orders from referring providers. If orders are received without the required information, the orders team will work with the ordering entity to verify insurance coverage.
Options for clinical decision support (AUC) consultation include:
Using electronic tools - EpicCare Link Private practices can still access EpicCare Link, a web-based version of NM Epic. EpicCare Link is available to independent clinics. Once registered with EpicCare Link, clinicians will have direct access to the decision support tools that guide the most appropriate image for the condition.
Using paper / faxed ordersTo avoid delay, follow these steps.
Calculate and score exam. Visit the CareSelect Imaging Open Access Portal to register for access to the tool that will enable you to calculate the appropriate use criteria (AUC) score for the order. The Imaging Open Access Portal is a web version of a qualified Clinical Decision Support Mechanism (qCDSM) that is available to all ordering providers, regardless of access to an EMR-integrated clinical decision support solution.
Document on the exam order the decision support session ID and vendor name.
Attest adherence to recommendation (yes/no).
Orders missing appropriate use criteria data will trigger a notification to the practice that updated orders are required.
Using your electronic health record. Configure your EHR system to consult a clinical decision support mechanism (applies to Shirley Ryan AbilityLab or clinics that use Greenway Prime Suite or eClinical Works).
Enter the vendor name and whether the order adheres to AUC criteria into the order questions at the time of ordering to satisfy the requirement.
For more information, or if you have questions, please contact MyNM Service Center at 312.926.4357. View updates to other diagnostic imaging initiatives such as Enterprise PACS Transition, Lung Cancer Screening and Image Exchange on NMI > System Initiatives > Enterprise PACS Transition > Diagnostic Imaging Key Initiatives.
Electronic Prior Authorization Available December 6 The new functionality will enable ambulatory clinics to perform prior authorization (PA) within Epic, rather than using a paper-based process or web portal.
With electronic prior authorization, prescribers and staff can:
Initiate prior PA at time of e-prescribing
Retrospectively initiate PA if it not completed during e-prescribing process
Complete PA questionnaires
Attach supporting documents to PA requests
Track progress and request status of PA requests
Live demonstrations will be held on the dates below: