AUC Education and Operations Testing Period Extended

CMS developed the AUC program to meet requirements of the Protecting Access to Medicare Act of 2014 (PAMA). 

A version of this article was first published August 26, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.

CMS extended the education and operations testing period for the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging through 2021.

The education and operations testing period, which started January 1, 2020, was slated to close at the end of the year. Payment penalties were scheduled to go into effect January 1, 2021.

CMS developed the AUC program to meet requirements of the Protecting Access to Medicare Act of 2014 (PAMA).

PAMA created a new program to help ensure that advanced diagnostic imaging services—PET scans, MRIs, CT scans, and nuclear medicine—provided to Medicare beneficiaries are appropriate and medically necessary.

The program was finalized in the 2017 Medicare Physician Fee Schedule (MPFS) final rule, and CMS finalized requirements for consulting and reporting in the 2018 MPFS, with additional updates included in the 2019 MPFS.

However, the ongoing novel coronavirus pandemic has reduced the demand for imaging services covered by the program and placed most organizations under significant financial strain, according to a letter jointly written by the AHA and the AMA.

Due to these factors, organizations have not been able to implement and test operational changes and train staff to comply with AUC requirements, according to the letter.

Although there are no payment penalties associated with the AUC program for 2020 and 2021, CMS encourages organizations to continue to use this time to prepare for full implementation. Currently, full implementation is still scheduled for 2022.