AI-POWERED CDSM
Get Your Patient Access Medicare Workflows Ready To Comply
Requirement to consult AUC with CDSM tool for advanced imaging procedures
Physicians ordering specific advanced imaging tests for Medicare patients will soon need to confirm their treatment decision by consulting appropriate use criteria (“AUC”) with a Center for Medicare Services (“CMS”) approved electronic clinical decision support tool (“CDSM”) pursuant to the Protecting Access to Medicare Act (“PAMA”).
Proof of consult required to get reimbursed by Medicare
Proof of such consult must then be provided to the rendering physician who submits it to Medicare along with the claim for reimbursement after the imaging test is performed. Reimbursements will be withheld if it is determined that the ordering physician did not consult a CDSM tool before ordering the procedure.
Implement early so your staff has time to learn
For those providers with a large base of Medicare patients and high imaging volume, delaying implementation of an approved CDSM tool and adjusting your workflows to include CDSM consults can risk revenue loss at a later date.
PATIENT ACCESS PLUS CDSM MANAGED BY ONE PLATFORM
Manage CDSM Certifications With Ease
Input patient and service details only once
Streamline the entire patient access workflow, including CDSM consults, from the same platform you input eligibility verification, benefit checks and prior authorization requests.
One dashboard shows all results
A unified dashboard shows results from all patient access activities.
Only platform that manages authorizations for commercial payers and Medicare
We are the only CMS-approved solution on the market that has developed a comprehensive CDSM solution that is integrated with automated eligibility and prior authorization workflows.
PHYSICIAN SUPPORT
High Quality Experience For Referring Physicians
Helpful clinical dashboard
A bi-directional integrated clinical dashboard provides immediate access to current patient information for both furnishing and ordering physicians.
Recommendations for appropriate procedures
Ordering physicians are provided with a high quality clinical decision support experience with an extensive library of AUCs sourced from multiple Qualified Provider Lead Entities (QPLEs) covering priority areas as detailed by CMS like CDI Quality Institute, National Comprehensive Cancer Network and American College of Cardiology.
Full compliance guaranteed
CMS requirements of consultation and reporting, as well as HIPAA, are met. After accepting patient details, a “compliance certificate” is provided for reimbursement.
HOW WE DO IT
Simple Workflow
Determines if CDSM consult is required
The referring physician refers to our CMS qualified CDSM portal to determine if CDSM is required based on payer, procedure, and diagnosis details.
Consult is performed
Patient diagnosis and other clinical indications are evaluated against the AUC the a recommendation is provided to the referring physician.
Select the preferred procedure
The referring physician selects the recommended procedure or a different one.
Obtain compliance certificate
They receive a compliance certificate with code starting with CDSM G-code 1018, unique consultation identifier, and adherence modifier, which is sent with the imaging order to furnishing provider, who can then submit it to Medicare along with the claim.
BENEFITS TO YOUR ORGANIZATION
We Take Care Of All CDSM Consults For You
Radiology, orthopedic, and cardiology groups, freestanding imaging centers, and outpatient hospital facilities are in the process of implementing the systems necessary for compliance with the upcoming CMS mandate.
Comprehensive AUC Coverage
Current clinical content with the ability to view AUC evidence for recommendations.
Proactive & Retroactive Compliance
Ability to generate proactive and retroactive compliance certificates if referring physician misses consult during order creation.
One Database
A single repository of all CDSM requests and consult certificates for CMS reporting.
No Integration For Referring Physicians
Ability to support physicians without integration into their EMR/EHR/RIS systems to exchange CDSM certificates.
EDUCATION
Helpful Resources For Your Team
We create educational materials frequently in the form of virtual office hours, articles, white papers, webinars and podcast episodes which help our clients and peers with common patient access challenges they face. If you would like us to address a specific topic, feel free to reach out to us.
