AUC Program: Are Your Billing Staff, Vendors Prepared for Start of Educational Year?

The "Educational and Operations Testing Period" of the new Appropriate Use Criteria (AUC) reporting program, established under the Protecting Access to Medicare Act of 2014, begins on Jan. 1, 2020. CMS did not make additional proposals about implementation or timelines in the recently posted CY 2020 physician fee schedule proposed rule. A recent change request transmittal from the Centers for Medicare and Medicaid Services (CMS) directs Medicare Administrative Contractors (MACs) how to process AUC-related HCPCS modifiers on claims as of this date. ACC members are encouraged to read CMS' related provider article and ensure billing staff and vendors are aware of this update.

ACC leaders and staff will continue to provide updates on the AUC program in the coming weeks and months in preparation for the start of the testing period. Additionally, your ACC continues to work with CMS, partner cardiovascular societies and the broader house of medicine to provide feedback on the program as implementation continues to move forward. Currently, full program implementation is expected Jan. 1, 2021. At that time, information regarding the ordering professional's consultation with a qualified clinical decision support mechanism (CDSM), or exception to such consultation, must be appended to the furnishing professional's claim for the claim to be paid. More information is available at the ACC's AUC Information Hub.

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services (U.S.), Decision Support Systems, Clinical, Healthcare Common Procedure Coding System, Medicare, Fee Schedules, Medicaid, Physicians, Referral and Consultation


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