Compliance: Begin Prep Now for New PAMA Rules and Regulations on ADIS Orders

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers the 2020 Medicare policy changes affecting advanced diagnostic imaging service orders under PAMA. It focuses on the roles of ordering and furnishing providers, the use of appropriate use criteria and a qualified clinical decision support mechanism, and the documentation and reporting workflow that support compliant claims processing. The piece is aimed at coders, billers, practice managers, and radiology staff who need to prepare for the operational and compliance impact of the new requirements.

Why This Topic Matters

The topic matters because imaging orders and related reporting workflows may be affected by new Medicare compliance expectations, creating a need for better coordination between referring offices and radiology practices. Understanding the scope of the change can help practices prepare their documentation and internal processes before enforcement-related reporting requirements take effect.

Article Sections

  1. See What PAMA Fully Entails

    Introduces the Medicare policy framework behind the new advanced diagnostic imaging order process and explains the general categories of imaging services involved. It also discusses the clinical decision support concepts referenced in the article and their relationship to ordering workflows.

  2. Consider Impact on Ordering, Furnishing Physician Practices

    Describes how the reporting process affects radiology practices, coders, and related administrative staff. It focuses on the documentation and claim-processing workflow changes associated with the new Medicare reporting environment.

  3. Begin Educating Providers Sooner Than Later

    Addresses coordination between referring providers and radiology teams, including preparation for documentation handling and operational readiness. It also references the transition period CMS provided for education and testing.

What You Will Learn

  • The general Medicare compliance changes affecting advanced diagnostic imaging ordering workflows
  • How the article frames the roles of ordering and furnishing provider organizations
  • What broad categories of documentation and reporting processes are involved
  • Why coordination between referring offices and radiology practices is emphasized
  • What kind of transition period CMS provided for preparation and testing

Who Should Read This

  • Coders
  • Billers
  • Practice managers
  • Radiology practice staff
  • Ordering providers
  • Furnishing providers

Codes Discussed

Modifiers Discussed


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