BC Advantage - 2022 Issue 7
Appropriate Use Criteria (AUC) Penalty Phase Set to Begin
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Article Overview
This article explains the upcoming Medicare Appropriate Use Criteria and Clinical Decision Support policy shift, including timing uncertainty tied to the public health emergency, claim-processing updates, exemption scenarios, and the roles of ordering and furnishing providers. It is relevant to radiology practices, interventional radiology, compliance staff, and billing teams that need to understand how the mandate affects outpatient advanced diagnostic imaging workflows and Medicare claims processing. The discussion also references professional society positions and current ACR resources related to appropriateness criteria.
Why This Topic Matters
Practices that order or bill for advanced diagnostic imaging need to understand how the AUC/CDS program changes Medicare workflow, documentation, and claims handling. Early preparation can help avoid disruptions when the penalty phase begins.
Article Sections
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Overview of the Mandate
Summarizes the Medicare AUC/CDS program and the general imaging services and provider roles affected by the policy.
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The Latest Information
Covers recent program updates from the Medicare Physician Fee Schedule final rule, including claim-processing and exemption-related topics.
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The Quandary of Interventional Radiologists
Discusses how the policy may apply in interventional radiology settings and the relevance of physician role distinctions.
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There Is Both Opposition and Support for AUC/CDS
Reviews differing professional and organizational perspectives on the program and mentions available support resources.
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Conclusion
Reiterates the need for practices to prepare for the program and related staff education and workflow planning.
What You Will Learn
- How the Medicare AUC/CDS program is changing over time
- Which broad imaging services and outpatient settings are affected
- What types of claim-processing updates and exemptions are being discussed
- How physician roles may affect compliance in interventional radiology settings
- What professional organizations are saying about the program and related resources
Who Should Read This
- Radiology practices
- Interventional radiologists
- Medical billers and coders
- Compliance staff
- Practice administrators
- Ordering physicians
Codes Discussed
Modifiers Discussed
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