New law seeks to reduce the number of inappropriate imaging exams

Starting January 1, 2017, physicians ordering advanced diagnostic imaging exams (CT, MRI, nuclear medicine and PET) must consult government-approved, evidence-based appropriate-use criteria, namely through a CDS system.

Physicians who provide advanced imaging services will be paid only if claims for reimbursement confirm that the appropriate-use criteria was consulted, which CDS mechanism was used, and whether the exam ordered was given an acceptable CDS rating. 

Consultation of appropriate-use criteria is required prior to the ordering of advanced diagnostic imaging services in the physician office, hospital outpatient, and emergency department settings.  Exams for inpatients and emergency services as defined under the Emergency Medical Treatment and Active Labor Act (EMTALA) will be exempt.

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07-17-2015 02:35 (EDT)