On January 1, 2020, an important federal mandate goes into effect that requires healthcare providers to consult Appropriate Use Criteria (AUC) when ordering Medicare Part B outpatient advanced imaging services. After January 1, 2020 all claims for these services require evidence of the consultation to be payable.
- Meditech selected CareSelect Imaging™, developed by to National Decision Support Company to offer a solution to enable compliance with this important requirement.
- NDSC brings years of experience in EMR data and solution management to create a new approach to decision support.
- CareSelect Imaging has been integrated with all Meditech platforms in use in the market today and is available as part of a MEDITECH delivered software update.
Through NDSC’s CareSelect Imaging solution, MEDITECH clients can access a comprehensive set of evidence based guidelines that cover a comprehensive range of imaging conditions, and the required functionality to generate payable claims . Our team provides the expertise to leverage and extend the capabilities of the EMR to provide maximum impact at the point of care.
Integrated Imaging CDS powered by National Decision Support Company
MEDITECH Supported – Market Validated
CareSelect Imaging is the MEDITECH Supported Solution for imaging decision support.
Trusted by leading EMR vendors and over 500+ Health Systems including 2700+ discrete acute care facilities covering 85% of the US population. The CareSelect Criteria Management and Delivery Platform processes over 3.5 million decision support interactions every month.
CareSelect Imaging Overview
Streamlined Guideline Delivery
The CareSelect CDSM integrates directly with MEDITECH to deliver AUC into the EMR – allowing you to stay up to date with the latest advisories and localize criteria as needed.
For each imaging order placed, MEDITECH makes a web service request to an external NDSC system. This consultation evaluates compliance with the applicable AUC and returns the information to MEDITECH to be displayed to the ordering user. The NDSC system will then embed all required data elements for a payable claim within MEDITECH.
Faster Time to Value
MEDITECH integration allows for a quick implementation timeline.
Keep your Criteria Current
Easily upgrade to the latest criteria sets with minimal on site work
Direct MEDITECH Integration
MEDITECH integrates seamlessly with CareSelect Imaging CDSM
A Complete Solution for PAMA — Assists with MACRA Participation
On March 26, 2014, Congress passed H.R. 4302, known colloquially as the Protecting Access to Medicare Act (PAMA). In it, Congress instructed the Centers for Medicare & Medicaid Services (CMS) to specify a program that requires physicians ordering certain imaging exams to consult with a qualified Clinical Decision Support Mechanism (CDSM) that relies on established Appropriate Use Criteria (AUC).
On April 16, 2015, Congress passed H.R.2, known colloquially as the Medicare Access and CHIP Reauthorization Act (MACRA). As part of MACRA, the Quality Payment Program established the Merit-Based Incentive Payment System (MIPS) to drive evidence-based and practice-specific quality improvement through a performance-based payment system.
On November 2, 2017, CMS published the CY 2018 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) Final Rules to revise PAMA and MACRA. These rules serve to align the qCDSM consultation requirements of the PAMA with the quality initiatives of MACRA and help to clarify the requirements for the creation of Clinical Decision Support (CDS) programs for compliant imaging AUC consultations.
CareSelect Imaging is fully qualified by CMS as a qCDSM and delivers a comprehensive set of structured indications and Appropriate Use Criteria (AUC) from five qPLEs, including all AUC from medical specialty societies. These guidelines are rationalized into a single delivery platform enabling full compliance with all aspects of PAMA. Our comprehensive coverage ensures that providers find the correct clinical question for every advanced imaging exam. This allows providers to access and view all required AUC and ensure that a payable claim is always generated.
The CY 2018 QPP Final Rule defined two MIPS Finalized Improvement Activities targeted at early adopters of the Medicare AUC program – AUC Consultation through a qCDSM and Cost Display for Laboratory and Radiographic Orders. As a qCDSM, CareSelect Imaging enables organizations to receive MIPS points in both the Improvement Activity and Advancing Care Information Performance Categories.
Comprehensive Criteria Sets
CareSelect Imaging criteria sets represent the highest quality, most comprehensive, evidence based decision support criteria. NDSC’s relationships with leading medical specialty societies ensure that CareSelect guidelines provide the most accurate and comprehensive decision support solution on the market.
When combined with the years of experience working with major EMR vendors to refine the point of order integration CareSelect criteria sets improve population health, reduce variations and gaps in care and facilitate enterprise wide cost reductions.
American College of Radiology | ACR Select™
ACR Select is a comprehensive, national standard based, clinical decision support database comprising over 3,000 clinical scenarios and 15,000 criteria. The platform provides evidence-based decision support for the appropriate utilization of all medical imaging procedures. More than 300 volunteer physicians, representing over 20 radiology and non-radiology specialty organizations, participate on the ACR AC expert panels to continuously update these nationally transparent guidelines, and provide real-time access to the latest medical imaging decision support.
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American College of Cardiology
Appropriate use criteria from the American College of Cardiology (ACC) offers the addition of over 250 clinical indications and 2000 clinical outcomes to provide widespread coverage of cardiac advanced imaging procedures. Criteria is authored by the ACC Appropriate Use Criteria Task Force who oversee the creation of topic specific indications. Topics are selected by the AUC Task Force after careful review of the current variation in utilization, stakeholder needs, procedure volume and cost, available evidence, and feasibility. Input is uniformly sought from ACCF councils and committees, cardiovascular and imaging specialty societies, non-cardiologists, and relevant stakeholders such as health payers, policymakers, and patients. The AUC are aimed at guiding both diagnostic and therapeutic procedures based upon specific, commonly encountered clinical scenarios. ACC AUC are both evidence-based and utilize expert consensus.
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National Comprehensive Cancer Network
NCCN Imaging AUC™ include recommendations pertaining to cancer screening, diagnosis, staging, treatment response assessment, follow-up, and surveillance. Additional information includes the indication, imaging modality, and frequency of use, as well as clinical notes related to the specific recommendation. NCCN Imaging AUC also document information on disease stage and histology. All imaging procedures recommended in the NCCN Guidelines®, including radiographs, computed tomography (CT) scans, magnetic resonance imaging (MRI), functional nuclear medicine imaging (PET, SPECT) and ultrasound, are included within NCCN Imaging AUC. NCCN develops imaging appropriate use criteria based upon each multidisciplinary Guidelines Panel’s evaluation of available scientific evidence, including published literature and the expert judgment of the panel members. The widely accepted NCCN Categories of Evidence and Consensus score individual NCCN Imaging AUC™.
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Society of Nuclear Medicine and Molecular Imaging
SNMMI follows a balanced multidisciplinary approach to guidance development. The SNMMI Guidance Oversight Committee has identified several high priority areas for AUC development ranging from Bone Scintigraphy for Prostate and Breast Cancer to Thyroid Imaging. CareSelect Imaging includes the growing list of SNMMI approved AUC.
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Society for Pediatric Radiology
SPR Imaging criteria has been developed by leading pediatric experts through the American College of Radiology’s Rapid Response Committee process with the support of the Society for Pediatric Radiology. These collaboratively developed guidelines add 374 indications and 376 exams that cover 2912 clinical end points for pediatrics and are delivered by NDSC as part of CareSelect Imaging. SPR AUC also considers radiation exposure, an important factor in pediatric imaging and allows for age filtering to display only the most pertinent content base on patients age and gender.
Recommended Implementation Timeline
Our recommendation is that organizations interested in maximizing their MIPS Scores through high-weight Improvement Activities and ACI bonus points implement CareSelect Imaging by July 2018. An early Implementation will assist in creating immediate financial impact and set the stage for a compliant PAMA implementation.
NDSC’s CareSelect™ Platform enables organizations to align their imaging and enterprise CDS programs to target high-priority Improvement Activities under MIPS. Targeted interventions in imaging, and in future, lab studies, blood management and other service lines can potentially impact scores across all four MIPS performance categories to maximize the overall MIPS Final Score.
MEDITECH will deliver the imaging AUC code as part of the MU3 update. Even if your organization is not attesting for MU3, your code delivery, implementation, and activation must be scheduled with MEDITECH and NDSC to confirm our collective availability for the agreed upon implementation window.
Start your CareSelect Imaging Journey Today
Meaningful change requires measurement. The sooner you begin to track and report on key performance metrics including imaging performance, the better.