Rhode Island Medical Imaging

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Clinical Decision Support

Starting January 1, 2020, referring providers that order Medicare Part B advanced diagnostic imaging services must consult Appropriate Use Criteria (AUC) through a qualified Clinical Decision Support Mechanism (CDSM). The referring physician must provide the appropriate information to the imaging facility so they can report the AUC consultation information on their Medicare claims.

Rhode Island Medical Imaging has provided a Clinical Decision Support Mechanism called Care Select for our referring providers to access. Link will be provided.

Read RIMI’s letter regarding Clinical Decision Support here.


A Clinical Decision Support Mechanism (CDSM) is an interactive, electronic tool for use by clinicians that communicates appropriate use criteria information to the user and assists them in making the most appropriate treatment decision for a patient’s specific condition.
 

Yes, all medical providers that order imaging exams for Medicare Part B patients must comply with the AUC Mandate unless they qualify for a hardship. Hardships are: insufficient internet access, electronic Medical Records or CDSM issues or extreme and uncontrollable circumstances.
 

All CT and MRI exams ordered by a medical provider for patients that have Medicare Part B insurance.
 

No, the mandate does not apply to Senior Managed Insurance Plans.
 

No, Rhode Island Medical Imaging will refuse Medicare Part B referred patients without the proper AUC documentation, as stated in the Appropriate Use Criteria Mandate.
 

The Clinical Decision Support Mechanism will ask for the referring provider’s NPI number, the patient’s name, date of birth, gender and Medicare ID number. You will also have to provide information about the patient’s signs and symptoms as well as the test being ordered. You may be required to answer additional clinical questions in order to complete the request. Based on what is entered, an appropriateness score will be generated.
 

No, the law and regulations are clear that the Appropriate Use Criteria consultation must be performed by the referring provider’s office.
 

As the ordering professional, you may delegate the Appropriate Use Criteria consultation to clinical staff acting under your direction if you do not personally perform the Appropriate Use Criteria consultation yourself.
 

Patients that present with an emergent condition are exempt from AUC. To qualify for an emergency exemption, the clinician only needs to determine that the medical condition manifests itself by acute symptoms of sufficient severity (including severe pain) such that absence of immediate medical attention could reasonably be expected to result in: placing the health of the individual (or a woman’s unborn child) in serious jeopardy; serious impairment to bodily functions; or serious dysfunction to any bodily organ or part.
 

The referring provider is responsible for providing the Appropriate Use Criteria consultation information to Rhode Island Medical Imaging as part of the order by electronically or manually writing it on the patient’s referral slip.
 

The referring provider will need to provide the name of the Clinical Decision Support Mechanism used and whether the result of the consultation was “adhere”, “not adhere”, or “not applicable.” A series of G codes will represent the CDSM used by the ordering provider and modifiers will represent the outcome of the Appropriate Use Criteria.
 

See below:

G1000 - Clinical Decision Support Mechanism Applied Pathways, as defined by the Medicare Appropriate Use Criteria Program

G1001 - Clinical Decision Support Mechanism eviCore, as defined by the Medicare Appropriate Use Criteria Program

G1002 - Clinical Decision Support Mechanism MedCurrent, as defined by the Medicare Appropriate Use Criteria Program

G1003 - Clinical Decision Support Mechanism Medicalis, as defined by the Medicare Appropriate Use Criteria Program

G1004 - Clinical Decision Support Mechanism National Decision Support Company, as defined by the Medicare Appropriate Use Criteria Program

G1005 - Clinical Decision Support Mechanism National Imaging Associates, as defined by the Medicare Appropriate Use Criteria Program

G1006 - Clinical Decision Support Mechanism Test Appropriate, as defined by the Medicare Appropriate Use Criteria Program

G1007 - Clinical Decision Support Mechanism AIM Specialty Health, as defined by the Medicare Appropriate Use Criteria Program

G1008 - Clinical Decision Support Mechanism Cranberry Peak, as defined by the Medicare Appropriate Use Criteria Program

G1009 - Clinical Decision Support Mechanism Sage Health Management Solutions, as defined by the Medicare Appropriate Use Criteria Program

G1010 - Clinical Decision Support Mechanism Stanson, as defined by the Medicare Appropriate Use Criteria Program

G1011 - Clinical Decision Support Mechanism, qualified tool not otherwise specified, as defined by the Medicare Appropriate Use Criteria Program
 
 

See below:

MA - Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition

MB - Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access

MC - Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues

MD - Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances

ME - The order for this service adheres to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional

MF - The order for this service does not adhere to the appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional

MG - The order for this service does not have appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional

MH - Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider

QQ - Ordering professional consulted a qualified clinical decision support mechanism
 
 

No, the imaging facility will not be able to use a reverse look up to obtain the AUC information.
 

Yes.
  • AgileMD’s Clinical Decision Support Mechanism
  • Applied Pathways CURION Platform
  • Cranberry Peak ezCDS
  • Evicore Healthcare’s Clinical Decision Support Mechanism
  • EvidenceCare’s Imaging Advisor
  • Inveni-QA’s Semantic Answers in Medicine
  • MedCurrent OrderWise TM
  • Medicalis Clinical Decision Support Mechanism
  • National Imaging Associates RadMD
  • Reliant Medical Group CDSM
  • Sage Health Management Solutions Inc. RadWise
  • Stanson Health’s Stanson CDS

 

Yes.
  • Aim Specialty Health Provider Portal
  • National Decision Support Company Care Select
  • Test Appropriate CDSM

 

Yes, there will be a Clinical Decision Support Mechanism Link on the www.rimirad.com website for our referring providers to access.
 

Please visit www.acr.org/cds for more information.
 

Please contact your RIMI Marketing Representative with any questions or concerns that you may have or you can email marketing@rimirad.com for further assistance.
 

 

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