Protecting Access to Medicare Act

Beginning Jan. 1, 2020, all providers ordering advanced medical imaging for eligible patients are expected to use appropriate use criteria (AUC) guidelines as outlined by the Centers for Medicare and Medicaid Services (CMS) in accordance with the Protecting Access to Medicare Act (PAMA) of 2014.

This will be done through a CMS-approved clinical decision support system, and will apply to CT, MRI, PET and nuclear studies ordered for patients at physician offices, after hours/urgent care, hospital outpatient departments (including emergency department, and observation), and ambulatory surgery centers.

To ensure compliance with PAMA, Noyes Health is integrating National Decision Support’s CareSelect Imaging with our electronic health records. CareSelect is a clinical decision support tool that offers evidence-based clinical guidelines solutions for diagnostic imaging.

The following are resources to help providers and caregivers who order imaging become familiarized with the CareSelect Imaging tool to prepare for this new law.

Providers may refer to this listing of Frequently Ordered Exams, and common clinical indications. This is a list of possible clinical indications, and is not all encompassing.

Consulting Appropriate Use Criteria

Meditech Providers

When ordering an advanced imaging exam, you will be prompted to enter the Reason for Exam in a free text field. Based on your entry, you may be launched to a web browser to consult AUC which will provide you with a score from 1-9 and possible recommendations for other orderable exams.

Non-Meditech Providers

You will be able to consult the CareSelect Open Access Portal (this link will take you to a one-time registration page) to generate a score for your exam. Enter an indication for the requested exam, which will generate a score. If you have access to consult AUC through your EMR, you will not need to consult the portal. If consultation information is not included on your order when it is submitted to a Noyes Health facility, you will be unable to get your patient scheduled for the exam. For more information on using the portal, please view the CareSelect Imaging Open Access User Guide and the CareSelect Imaging Open Access FAQs.

The following documents are provided to assist the user in registering for and utilizing the CareSelect Open Access Portal:

• CareSelect Imaging Open Access Portal Registration
• CareSelect Imaging Open Access Portal Quick Guide

You must provide the following information on the requisition:

• Vendor (If using the CareSelect Open Access Portal, please enter NDSC)
• Decision Support Number
• Appropriateness Score
• Consultation Results
• Acknowledgement Reason and Comment (when appropriate)

Schedulers

A score will be automatically generated for orders placed through Meditech. However, a score will need to be provided for ancillary orders. If a score is not included on the requisition, please direct the provider to the CareSelect Open Access Portal so that they can get the required information.