• CMS delays enforcement of Appropriate Use Criteria program

    The Centers for Medicare & Medicaid Services (CMS) recently announced it has extended the education and testing period for its Appropriate Use Criteria (AUC) program through calendar year 2021. Without the extension, clinicians who ordered imaging tests such as CT, MRI or nuclear medicine for Medicare beneficiaries would be required to first consult a qualified clinical support computer program through an electronic portal to confirm the order fit the criteria for appropriate use. Now, claims will not be denied for failing to do so during the extended testing period. The extension gives clinicians more time to prepare, penalty free.  

    The AUC program was established by the Protecting Access to Medicare Act of 2014 (PAMA). Initially, it was mandated to begin in 2017, but the program has been difficult to operationalize, and full implementation has been repeatedly delayed.

    The American Academy of Family Physicians (AAFP) has advocated for Congress to repeal the AUC program, or give the Health and Human Services Secretary the flexibility to change the program or exempt certain providers. The AAFP has also advocated CMS use its authority to delay implementation and exempt Advanced Alternative Payment Model participants.

    – Amy Mullins, MD, CPE, FAAFP; medical director, quality and science, AAFP

    Posted on Aug 18, 2020 by FPM Editors

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.