Home Forums Discussions General Discussion Medicare PAMA Requirement

The new PAMA requirement that started this year requires ordering physicians to consult with Appropriate Use Criteria prior to ordering advanced diagnostic imaging.

I checked with AC support and they responded that AC "is not planning to implement anything at this time for the PAMA program. We are looking into options, and hoping to have an interface maybe sometime later in 2020."

Does anyone have recommendations for a free program in the interim? I looked at the Medicare website but most of the free programs listed there are an interface for EMR. I was hoping to find one that was a separate portal.

Both imaging facilities we work with offer a free system for this, so I'd suggest checking with the companies you use most often to see if they have something in place. They have a vested interest in making sure these get done, since they're the ones who won't be paid.

And I thought CMS postponed the requirement, so that 2020 is an "educational" year and the requirement actually starts 2021.
Is that not correct?

That is correct. There's no penalty this year, but we're supposed to get in the habit of doing them, I suppose. Because it's CMS - they never change their minds, right? ;-)

Hi everyone,

Interestingly, even though this current year is not "mandatory" the local hospital (Western Maryland Health System) is saying that it is requiring an authorization number on all CT, MRI, and nuclear studies. It is saying that the studies will not be scheduled without authorization number.

The free standing radiology center (ADR) sent out a memo saying it is requiring an authorization number, but unofficially has said it will not be enforcing until January 1, 2021.

The hospital has contracted with CareSelect, there is no cost for a provider to enroll (at least for us.) The radiology place said that it will use the same, so we do not have to learn two systems.

I have done a couple of authorizations, the system can be very cumbersome to use, the search feature for both tests and diagnoses is not very user friendly. However, the "bar" for obtaining authorization seems fairly low.

Any one else have an experience to share?

Thanks.

Gene