Why is SAM-AUC needed?
In 2014, the Protecting Access to Medicare Act (PAMA) law was passed to define the Appropriate Use Criteria (AUC) program. This program requires referring physicians to consult a CMS qualified Clinical Decision Support Mechanism (qCDSM) using qualified Provider Led Entity (qPLE) developed content when ordering ambulatory advanced imaging for Medicare enrollees. The AUC are defined as criteria that are evidence-based and designed to assist care providers who order advanced imaging services to make the most appropriate treatment decisions for a specific clinical condition. As more providers are reimbursed based on the "value" of the care provided, there is an added incentive to order the most appropriate diagnostic tests for improvements in quality, workflow efficiency, enhanced communication, data collection and cost savings.
How does SAM-AUC assist my organization in complying with the PAMA requirements?
In 2019, CMS designated InveniQA's SAM-AUC as a qCDSM for all ambulatory advanced imaging orders. This means SAM-AUC meets the CMS requirement that advanced imaging orders are generated and documented using a qCDSM for Medicare claims beginning January 1, 2020. SAM-AUC provides the CMS required g-code and modifier(s) on imaging orders for all Medicare CDS claims to keep your organization complaint and ensure reimbursement. Beginning January 2021, payments will be denied without submitting this information.
Can SAM-AUC be used to improve MACRA/MIPS quality reporting scores?
Yes, SAM-AUC qCDSM is a recommended MACRA/MIPS Improvement Activity by the American College of Radiology providing Patient Safety & Practice Assessment to improve quality scores. In 2019, CMS classified the use of AUC in two (2) MIPS categories, Improvement Activity credit and Promoting Interoperability bonus points. MIPS is also a major track of the value-based reimbursement system and CMS predicts 800,000 Part B clinicians will be subject to MIPS for the 2019 performance year and continuing through 2022.
What happens when the guidelines change?
SAM-AUC clinical content is updated annually in accordance with CMS requirements for updating AUC. In addition, InveniQA updates SAM-AUC as needed when new findings, protocols and best practices are published in medical literature.
Who provides the appropriate use criteria (AUC) for SAM-AUC?
SAM-AUC has licensed the AUC developed from the qPLE Sage Evidenced-based Medicine & Practice Institute (SEMPI) providing complete coverage of ALL eight CMS defined Priority Clinical Areas and related diagnosis codes.
Who uses SAM-AUC?
Primary users are physicians/clinical staff ordering the diagnostic imaging for any outpatient setting including emergency rooms and surgery centers, radiology groups receiving and performing the procedures (IDTFs or hospital radiology departments), and patient-facing radiologists. Although an ordering professional must place the order, other staff may complete or review the order to fit their workflow. The data generated from the system is available to users and administrators who may want to review processes, utilization, outcomes and trends.
Is SAM-AUC easy to use?
SAM-AUC is user-friendly, intuitive and easy to learn. No special hardware is required. All you need is internet access through your mobile device or laptop. The ordering process usually takes less than two minutes to order and transmit an imaging request. Training typically takes less than 15 minutes.
How does SAM-AUC integrate with my current systems?
SAM-AUC is a stand-alone cloud based intuitive web services solution, providing ordering professionals specific evidenced-based, symptom-driven recommendations. SAM-AUC is also available as a stand-alone portal or in conjunction with radiology service providers of management and billing technology.
What reports and analytics are provided by SAM-AUC?
SAM-AUC basic reporting meets the provider reporting requirements of PAMA. Reports and analytics are available to review ordering patterns, utilization and estimated radiation exposure to improve quality of care and patient safety.
Who purchases SAM-AUC?
In general, imaging services providers will contract for a qCDSM since they need to file CMS claims for maximum reimbursement.