I've listened to a few webinars over the last year regarding AUC and several presenters stated that if Medicare is secondary, then the CDSM needs to be consulted. However, I just read a snippet in the Federal Registry stating that consulting a CDSM for Medicare secondary is not necessary. I provided the snippet and would like to know if that's how you read the statement? Thank you in advanced for your feedback.
(This document is scheduled to be published in the Federal Register on 07/23/2021 and available online at federalregister.gov/d/2021-14973, and on govinfo.gov)
| Medicare as a Secondary Payer (pg. 401) |
We understand based on feedback from stakeholders that, in some EHRs, the primary payer information is readily available and known to the ordering professional; however, secondary payer information typically is not available. Additionally, it is possible that when Medicare is the secondary payer that no Medicare payment would be made at all after the primary payer makes payment. Medicare is reported as the secondary payer for approximately 1.5 percent of advanced diagnostic imaging services that are subject to the AUC program. Because the secondary payer information for a patient generally is not available to the ordering professional, and because no Medicare payment may be involved at all when Medicare is the secondary payer, we propose to exclude claims that identify Medicare as the secondary payer from application of the AUC consultation and reporting requirements. Specifically, we propose to allow claims that identify Medicare as the secondary payer (using block 1 or the electronic equivalent of the practitioner claims and using FL 50/51 or the electronic equivalent of institutional claims) to bypass the AUC program claims processing edits.
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Taleesha Hawes
Director of Coding
MedQuest Associates
Alpharetta GA
(770) 687-3703
www.mqimaging.com------------------------------