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  • 1.  New CMS Pilot Project - Outreach to Physicians who Order Tests to Provide Medical Necessity Information

    Posted 03-22-2021 12:42
    CMS has announced a pilot program to require MACs to also reach out to ordering physicians, "when necessary," to obtain medical information to support the medical necessity of orders for diagnostic radiology studies. "There are instances in which radiology service providers selected for review are unable to acquire supporting documentation, possibly retained by the treating/ordering practitioner. CMS is piloting an approach that will enable MACs to receive pertinent documentation from the treating/ordering practitioner during medical review, in an effort to support the necessity and payment for radiology service(s)/item(s) billed to Medicare."

    https://www.cms.gov/files/document/r10579otn.pdf


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    Thomas W Greeson
    Reed Smith LLP
    (703) 517-0495
    tgreeson@reedsmith.com
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  • 2.  RE: New CMS Pilot Project - Outreach to Physicians who Order Tests to Provide Medical Necessity Information

    Posted 03-23-2021 09:19

    Good morning Tom-

    Would you anticipate this being a rare occurrence or to become more common as providers still struggle to support those orders from RPs? If no supporting documentation is provided or available from the treating/ordering practitioner- would the imaging provider still be penalized? 

    That brings us back to AUC- any feelings on if CMS will still move forward with implementation in 2022? 

    Thanks for any insight!




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    Vicki Melendez
    Radiology Regional Center
    Fort Myers FL
    239-936-2316
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    Original Message


  • 3.  RE: New CMS Pilot Project - Outreach to Physicians who Order Tests to Provide Medical Necessity Information

    Posted 03-23-2021 09:46

    Morning, Vicki.

     

    The transmittal announced this as a pilot program, but radiology groups are advised to bring it to the attention of any review organization seeking medical record documentation when such information is not easily forthcoming from the ordering physician's office.

     

    Great question on the AUC/CDS program. I recommend that every radiology practice  prepare themselves and their referring doctors for full implantation in 2022, but to monitor updates from CMS on whether education and testing will be extended another year.

     

    Thomas W. Greeson

    703.517.0495 (cell)

    tgreeson@reedsmith.com

    Pronouns: He/Him/His

     

    Reed Smith LLP

    7900 Tysons One Place

    Suite 500

    McLean, Virginia 22102-5979

    Office Telephone: 703 641 4242

    Facsimile:   703 641 4340

     

     

     

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