Protecting Access to Medicare Act (PAMA)

As part of PAMA (H.R. 4302) congress instructed CMS to define a program that requires ordering physicians to consult a qualified clinical decision support mechanism (qCDSM) using qualified Provider Led Entity (qPLE) developed content of Appropriate Use Criteria (AUC) when ordering outpatient advanced imaging.

Timeline based on recent CY 2018 Ruling CMS-1676-F

April 2014

PAMA signed into law

July 2017

RadWise® accredited as a qualified CDSM /  - qPLE

January 2018


CDSM is a heavily weighted improvement activity to maximize MIPS quality scores

Voluntary participation and testing of qCDSM data on claims

Mid 2018 -  2019

CMS Educational and Operational Testing year - No claims denied

January 1, 2020

qCDSM Required

qCDSM Required - Claims to be denied

January 1, 2021

Earn Incentives 

January 1, 2018 providers and organizations can improve MACRA/MIPS quality scores with a qCDSM

Protection of Reimbursements

January 1, 2020, Services & Professionals need to leverage referring provider to use a qCDSM

Claims Denied

January 1, 2021, qCDSM is required to prevent CMS claims denial