NextGen Office, the leading cloud based EHR solution now provides the new Appropriate Use Criteria or AUC program solution for radiology orders in the patient encounters or chart orders tab.

Why You Need to Use AUC When Creating Radiology Orders in NextGen Office

The Protecting Access to Medicare Act (PAMA) of 2014 created a new program to increase the rate of appropriate services provided to Medicare beneficiaries.

Examples of such advanced imaging services include:

  • Computed Tomography (CT)
  • Positron Emission Tomography (PET)
  • Nuclear Medicine, and Magnetic Resonance Imaging (MRI)

When a provider 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 appropriate use criteria (AUC) is accessed. The CDSM provides a determination of whether the order adheres to AUC, or if the AUC consulted was not applicable .

A consultation must take place at the time of the order for imaging services that will be furnished in one of the below settings and paid for under one of the below payment systems.

This program impacts all providers that order advanced diagnostic imaging services and the facilities that furnish advanced diagnostic imaging services in a physician’s office, and whose claims are paid under the physician fee schedule.

new! - mips improvement activity

Consulting AUC Using Clinical Decision Support when Ordering Advanced Diagnostic Imaging is a high weighted Improvement Activity, adding 20 points to your MIPS IA score!

Program Timeline

Starting on January 1, 2021 AUC consultations with qualified CDSMs are required to occur along with reporting of consultation information on the furnishing professional and furnishing facility claim for the advanced diagnostic imaging service. Claims that fail to append this information will not be paid. 

NextGen Healthcare partnered with National Decision Support Company (NDSC) and has integrated their solution (CareSelect) within the NextGen Office EHR.

Now when you create an order for an advanced imaging study this feature will allow you to query the AUC Program inside the radiology ordering workflow. This feature is automatically enabled for all practices.

How to use auc when creating a radiology order in the nextGen office Ehr

  1. Select Orders in either the Plan section of your encounter note or from the Orders tab of the chart to create the order
    Create a radiology order in nextgen office

  2. Select the facility where the test is to be performed, add the diagnosis and procedure codes. If the test requires an AUC you'll be prompted to begin one

    Choose cpt code in NextGen office when creating radiology order

    How to consult the AUC if one is required in NextGen Office

    In NextGen Office you'll be prompted to proceed for the required AUC

  3. The CDSM is automatically queried and you're asked to select an indication based on diagnosis

    The CareSelect AUC opens in NextGen Office and you're prompted to select a diagnosis

  4. The CareSelect application provides the appropriateness rating for the test ordered and includes alternative tests and their respective rating. The requested test shows below Requested Exam and appropriate tests with higher ratings show below Appropriate Exams.

    Rating scale: 1-3: usually not appropriate, 4-6: may be appropriate, 7-9: usually appropriate

    1. Confirm the requested test
    2. Click Confirm & Order.
      If the requested test has a rating of 3 or lower, select the reason and click Submit. Comments are optional.
      Replace the requested test with a more appropriate test
    3. Click Replace & Order.
      To view the American College of Radiology appropriateness criteria for this clinical condition, click View Evidence for Exams at the top of the window. You can download a PDF of the report.

      In our example, there is an MRI that is more appropriate for our patient. We select 70551 with the higher rating by clicking Replace & Order.

      NextGen Office provides you with the option to confirm or cancel based on the AUC results

  5. The AUC shows completed next to the tests indicating the consultation has been completed.

    After the AUC has been completed in NextGen Office you create the radiology order

 

Click here to Download the FAQ's on the Appropriate Use Criteria (AUC) in NextGen Office

If you have additional questions about AUC, creating Radiology or Consult order in the NextGen Office  cloud based EMR please contact AVS Medical, your national NextGen Office Partner or call at 877-975-9160.

If you're interested in learning more about NextGen Office EHR please click below!

Learn More about NextGen Office

 

* UPDATE: After this post was initially published the following was posted on the CMS website here:

NOTICE: The EDUCATIONAL AND OPERATIONS TESTING PERIOD for the AUC Program has been extended through CY 2021. There are no payment consequences associated with the AUC program during CY 2020 and CY 2021. We encourage stakeholders to use this period to learn, test and prepare for the AUC program.

AVS Medical

Written by AVS Medical