Part of the Protecting Access to Medicare Act of 2014 (PAMA), the CMS Appropriate Use Criteria Program aims to improve the quality of care and reduce inappropriate imaging for Medicare fee-for-service beneficiaries. It requires that providers consult appropriate use criteria from a CMS-qualified clinical decision support mechanism, or tool, when ordering outpatient advanced imaging services for these patients.
We are deeply involved in the CMS program: we have developed appropriate use criteria (AUC), and we are a qualified clinical decision support mechanism (CDSM).
To develop the criteria, we collaborated with the Center for Diagnostic Imaging Quality Institute, a nonprofit affiliate of Center of Diagnostic Imaging and a CMS-designated provider led entity. Our collaboration with them allows us to license and use the AUC.
To become a qualified CDSM, we applied to CMS as required. On July 13, 2017, CMS recognized our commitment to clinical excellence and evidence-based care by designating us as a qualified CDSM. The designation enables us to deliver the AUC to providers through AIM Inform.
AIM Inform meets both requirements: it is a CMS-qualified clinical decision support mechanism, and it includes the appropriate use criteria and supporting documentation providers need when ordering advanced imaging for Medicare fee-for-service beneficiaries.