The Explanation: A new CMS initiative with a 1/22 deadline calls for physicians who refer Medicare/Medicaid patients for advanced imaging exams (CATs, PETs, MRIs, nuclear) to have their ordering decisions be confirmed through a qualified clinical decision support mechanism (qCDSM).
While not part of the initiative itself, ideally, the qCDSM would accessed directly through the referring physician’s EHR which produces a confirmation for the patient’s exam based on any number of factors, the patient’s condition, complaint(s), etc. Or, it may not provide a confirmation.
The Penalty: Ironically, referring physicians who fail to comply with the initiative won’t be penalized, but the imaging center that provides the types of advanced studies noted for Medicare/Medicaid patients will have their claims denied if performed without having the proper confirmation code from the referrer’s side.
The Fallout: Once the deadline hits, providers will have a difficult – perhaps impossible – time finding imaging centers to accept patients who fit the described profile if there’s no confirmation for the particular exam type.
The ADS Solution is actually two-fold:
- The MedicsCloud EHR - which is available at no cost with MedicsRCM or through our MedicsCloud Suite - is enabled for decision support through a collaboration with the ezCDS qCDSM. Referring physicians simply enter data as they normally would through the MedicsCloud EHR. Without having to exit the EHR, ezCDS will either generate the code which the provider can make available to the imaging center, or provide an explanation if one isn’t produced.
- Our MedicsRIS (radiology) clients will be able to offer access to ezCDS through the MedicsRIS portal for referrers who don’t have their own qCDSM, helping to ensure themselves against denials.
So, if you’re on the referring side, you’re able to access the MedicsCloud EHR and the ezCDS option as a MedicsRCM client or through the MedicsCloud Suite if an in-house platform is preferred. If you’re an imaging center, you can make ezCDS available as an option to your referrers also through MedicsRCM or with MedicsRIS as an in-house system.