Appropriate Use Criteria Program
The Protecting Access to Medicare Act of 2014 includes a provision requiring ordering professionals to consult with appropriate use criteria (AUC) through a clinical decision support mechanism (CDSM) for all Medicare patients receiving advanced imaging (cardiac nuclear, CT, MR). Under the law, only AUC developed by entities meeting the qualified "provider-led entity" (PLE) standards as defined by regulation can be used under the Centers for Medicare and Medicaid Services' (CMS) AUC Program. The ACC is recognized as a qualified PLE for a five-year period, ending in June 2021, to develop and modify AUC under the Medicare AUC program for advanced diagnostic imaging. As a result, the national AUC developed by the College will be an accepted standard for cardiologists and others when submitting to Medicare for the review of cardiac imaging.
In the coming months, Medicare will propose and publish specific regulations and instructions on how ordering and imaging professionals are to participate in the AUC Program. Below is the estimated program timeline for release of those regulations. The ACC will continue to update this page with the AUC Program details to help members successfully meet these requirements.
- Nov. 1, 2016: 2017 Physician Fee Schedule (PFS) final rule released outlining CDSM requirements and process to become qualified
- Jan. 1, 2016: CDSM applications are due from prospective developers
- June 30, 2017: CMS expects to release list of qualified CDSMs
- July 2017: CY 2018 PFS proposed rule will include instructions on reporting CDSM results
- Oct./Nov. 2017: CY 2018 PFS final rule expected to include process for reporting CDSM results
- No earlier than Jan. 1, 2018: Ordering physicians begin reporting CDSM results