The Protecting Access to Medicare Act (PAMA) authorized Medicare to promote the use of “appropriate use criteria” (AUC) before ordering advanced diagnostic tests — such as advanced imaging as well as the use of clinical decision support mechanisms in eight clinical areas — for Medicare patients. WSHA Industry partner PARA Healthcare Financial Services has written a paper detailing developments regarding this topic.
Over time, this may lead to greater consistency and uniformity of the medical necessity requirements and mechanisms used by health plans. (Andrew Busz)
