AUA Urges CMS to Study the Effects of Implementation of AUC

By Policy and Advocacy Brief posted 06-07-2022 11:01


On May 17, the AUA joined with the American Medical Association (AMA) to send a letter to the Centers for Medicare & Medicaid Services (CMS) regarding CMS’ reporting requirements to the Congress about the implementation of the Appropriate Use Criteria (AUC) Program. In the letter, the AMA requests that CMS consider engaging with physicians before preparing its report to Congress. The AMA highlighted that CMS should assess the impact of AUC on small and rural practices, release additional drill-down data about the Education and Operations Testing period and evaluate alternatives to claims-based reporting for AUC information and include it in the final report.

According to CMS, the Appropriate Use Criteria program works to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. Under this program, at the time a practitioner orders an advanced diagnostic imaging service for a Medicare beneficiary, they will be required to consult a qualified Clinical Decision Support Mechanism (CDSM). CDSMs are electronic portals through which AUC is accessed. The CDSM provides a determination of whether the order adheres to AUC or if the AUC consulted was not applicable. This program impacts all physicians that order advanced diagnostic imaging services. Read a full overview of the AUC Program.

The letter is attached.