Washington E-Newsletter

Appropriate Use Criteria Program Penalty Phase Delayed

On July 7, CMS announced that the agency is indefinitely delaying the penalty phase of the Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging. The program requires physicians ordering advanced diagnostic imaging for Medicare beneficiaries to consult AUC and communicate specific AUC information to the rendering physician, who must then attach the AUC information to the imaging claim to be paid. CMS had previously announced that it would begin penalizing physicians who failed to consult with AUC beginning with the first January after the end of the COVID-19 public health emergency. Given the ongoing challenges CMS is facing with implementation and costs and hassles associated with compliance, this delay is welcome news for neurosurgeons.

Earlier this year, the AANS and the CNS joined more than 40 national medical specialty societies in urging CMS to reassess the program as part of a report the agency is preparing for Congress. In addition, the neurosurgery delegation to the American Medical Association (AMA) collaborated with the radiology associations and others on updated AMA policy related to the program. The new AMA policy states:

Our AMA will advocate to Congress and the Centers for Medicare & Medicaid Services (CMS) to delay implementation of and advance modifications to the Medicare Appropriate Use Criteria (AUC) Program in such a manner that exempts care mandated by EMTALA, adequately addresses technical and workflow challenges that add to clinician’s administrative burden and practice expenses, maximizes alignment with the Quality Payment Program (QPP), and creates provider flexibility for the consultation of physician-developed, evidence-based and transparent AUC or advanced diagnostic imaging guidelines using a mechanism best suited for their practice, specialty and workflow.

The AANS and the CNS will continue advocating for Congress to repeal or modify the program.