MEDHOST® to enable CareSelect® Imaging Integration for its Customers

CareSelect Imaging offers a comprehensive CDS solution for advanced imaging and provides a pathway to fulfill PAMA Mandate

FRANKLIN, Tenn. – March 06, 2019 – MEDHOST, Inc., a provider of market-leading fully integrated electronic health record (EHR) and healthcare engagement solutions, announced today that it is enabling integration with National Decision Support Company’s (NDSC) CareSelect Imaging for its customers which will deliver Appropriate Use Criteria (AUC) into the MEDHOST EHR solution.

“CareSelect Imaging delivers AUC, authored by leading medical specialty societies, directly into MEDHOST’s fully integrated EHR workflow at the point-of-order,” said Bob Cooke, VP of Marketing and Strategy at NDSC. “This empowers enterprise-wide quality improvement efforts and a pathway to compliance with the Protecting Access to Medicare Act (PAMA) AUC consultation requirements.1”

This extension is designed to promote more reliable standards, reduced variation of care, and the data you need to improve performance. These factors lead to better patient care, improved population health, increased provider efficiency, and lower cost of care.

 

1Legislative Requirement

The Protecting Access to Medicare Act (PAMA) directed CMS to establish a program to require the consultation of Appropriate Use Criteria (AUC) for the ordering of advanced diagnostic imaging services. CareSelect Imaging is a qualified Clinical Decision Support Mechanism.

The AUC program consists of four components:

  • Provider Led Entities (PLEs), which follow evidence-based processes to develop, modify, or endorse AUC.
  • Clinical Decision Support Mechanisms (CDSMs) are the electronic portals through which clinicians access the AUC during the patient workup.
  • AUC consultation by ordering physicians and reporting on AUCs consultation. Ordering providers are required to consult AUC for all Medicare Part B Advanced Diagnostic Imaging Services (CT, MR, NM, PET) and for the furnishing professional to include on the Medicare claim information about the ordering professional’s consultation with a qualified CDSM.
  • Annual identification of outlier ordering professionals for AUC related services furnished.  Beginning in CY 2021, CMS will perform claims analysis and provide further guidance concerning payment adjustments. CMS has outlined eight Priority Clinical Areas (PCAs) as a baseline of clinical coverage to measure outlier physicians. Outlier calculation will be based on both AUC adherence within the PCAs and applicability of the AUC to the service.

The PFS for CY 2019 finalizes some AUC requirements:

  1. Jan 1, 2020 starts a year-long educational and operations testing period. During this period, AUC consultation must occur across all advanced imaging and AUC consultation information is expected to be reported on claims, however claims will not be denied for failure to include proper AUC consultation information.
  2. Consultation is required in all applicable settings as outlined by CMS. These include physician offices, hospital outpatient departments (including emergency departments), ambulatory surgical centers, and independent diagnostic testing facilities. Each organization will need to assess its requirements accordingly.
  3. AUC consultation must be performed by the Ordering Professional (OP) or clinical staff operating under the direct supervision of the OP.
  4. G-codes and modifiers will be used to report the required AUC consultation information on the Medicare claim. The G-code will be used to define the qCDSM ID and CPT will be amended with HCPCS modifiers to indicate pertinent AUC consultation data.

 

About MEDHOST

MEDHOST has been providing products and services to healthcare facilities of all types and sizes for 35 years. Today, more than 1,000 healthcare facilities are partnering with MEDHOST and enhancing their patient care and operational excellence with its clinical and financial solutions, which include a fully-integrated EHR solution. MEDHOST also offers a comprehensive emergency department information system with business and reporting tools. Additionally, its unparalleled support and hosting solutions make it easy to focus on what’s important for healthcare facilities: their patients and business. Connect with MEDHOST on Twitter, Facebook and LinkedIn.

About National Decision Support Company

National Decision Support Company, a Change Healthcare Company, offers CareSelect® Clinical Decision Support and Analytics solutions that are designed to influence clinician ordering to manage utilization and control costs while reducing administrative burden and streamlining the payor-provider data exchange. CareSelect delivers medical guidelines at the point-of-order and measures provider interaction to foster dynamic clinical transformation and revenue cycle optimization programs across the enterprise. CareSelect has been adopted by over 500 health systems covering over 5,000 facilities which process over 5 million decision support transactions each month.

Contact:
Samra Khan
Enterprise Brand Manager
615-761-1000, ext. 2119
Samra.Khan@medhost.com