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 / SEMPI.org - qPLE
January 2018
Incentives
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