JACC Leadership Page: Using Appropriate Use Criteria to Address Pre-Authorization

In a recent Leadership Page published in the Journal of the American College of Cardiology (JACC), Robert A. Shor, MD, chair of ACC’s Board of Governors, discusses solutions within appropriate use criteria (AUC) for understanding and addressing claims denials and pre-authorization issues. “We are approaching the radiology benefits management companies to help us understand what is occurring from their perspective in terms of denial rates, prior authorization processes, variation, and best practice,” states Shor. One solution may include ACC’s Focus Initiative, which helps providers better understand their imaging practices, identify areas for improvement and incorporate AUC at the point of care. “The College is looking forward to results from pilot efforts in several states that use FOCUS, either as a radiology benefits management alternative, or as part of an alternative payment model. If successful, these programs could lead to greater collaborations with payers, hospitals, state medical societies and other stakeholders.” Read more.