decisionhealth Newsletters, Part B News - 2019 Issue 9 (September)
Take AUC testing year to see how well your reporting works — and how well docs take it
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Article Overview
This article explains the Medicare appropriate use criteria (AUC) testing year for advanced imaging and what it means for practices that order affected outpatient imaging services. It covers the CMS framework, clinical decision support mechanism reporting, vendor readiness, exemptions, internal preparation, and how organizations can use the testing period to evaluate workflow and provider response before the program carries enforcement consequences. The piece is aimed at physicians, administrators, radiology groups, and practice managers who need to understand the operational side of AUC compliance.
Why This Topic Matters
The testing year gives practices a chance to assess readiness before AUC reporting becomes more consequential. Understanding the program’s scope, workflow implications, and documentation requirements can help organizations avoid disruption and prepare for possible prior authorization triggers.
Article Sections
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AUC background and CMS timeline
Introduces the Medicare appropriate use criteria framework for advanced imaging and summarizes the CMS implementation timeline. It also places the program in the context of federal policy and outpatient care settings.
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Clinical decision support and reporting requirements
Explains the role of clinical decision support mechanisms in the ordering workflow and the need to document consultation results. It also describes the program’s reporting structure at a high level.
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Priority clinical areas and later consequences
Outlines the clinical areas CMS is reviewing during the early program years and notes the potential downstream impact for providers whose patterns fall outside expected standards.
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Testing year and implementation preparation
Describes the 2020 testing year and offers broad preparation themes for practices evaluating readiness. It focuses on workflow, vendor planning, and internal coordination.
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Run-up tips for AUC
Summarizes practical preparation topics for organizations considering the transition. The section addresses applicability, tool selection, vendor status, provider communication, and planning for internal review.
What You Will Learn
- How the AUC program fits into the Medicare imaging environment
- What the testing year is intended to help practices evaluate
- Which operational areas practices should review before full implementation
- How organizations can think about vendor readiness and workflow integration
- Why communication and internal monitoring matter during the transition
Who Should Read This
- Physician practices
- Radiology groups
- Practice managers
- Health information technology leaders
- Compliance and revenue cycle staff
- Medical group administrators
Codes Discussed
Modifiers Discussed
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