A bipartisan bill introduced in the U.S. Senate on May 9 seeks to remove a key barrier that has delayed implementation of Medicare’s Appropriate Use Criteria (AUC) program.
Sens. Marsha Blackburn (R-TN) and Catherine Cortez Masto (D-NV) explained that S 1692, the Radiology Outpatient Ordering Transmission (ROOT) Act, will eliminate Medicare's real-time claims reporting requirement and require providers to attest to reviewing AUC at the point of care.
Further, the Centers for Medicare and Medicaid Services (CMS) would conduct retrospective audits based on this data to ensure compliance and inform provider education, they added. An additional carveout reduces administrative burden, exempting those participating in clinical trials and those in small rural practices, according to the legislators.
Blackburn and Cortez Mastro estimated that the proposed legislation could reduce federal spending by $2.2 billion from fiscal year (FY) 2025 to FY 2034, as well as reduce Medicare beneficiary cost-sharing by $1.6 billion over the same period if successful.
The legislation is supported by the Tennessee Radiological Society, American College of Radiology (ACR), and American Society of Emergency Radiology.
“The quality-based AUC ordering approach is good for patients, providers, and taxpayers," said American College of Radiology CEO Dana Smetherman, MD, in the related announcement. "The ACR urges health systems, hospitals, and practices to build on their [clinical decision support] CDS investment, and for Congress and CMS to continue to work with medical associations, providers groups, and other stakeholders to implement the federal AUC program."
Congress mandated that the Protecting Access to Medicare Act (PAMA) Imaging AUC program be implemented in 2017, ACR noted in its announcement, but CMS was unable to fully launch the program.
The ROOT Act reflects input from multiple medical societies and stakeholders and will amend PAMA to ensure that CMS implements the AUC program without delay and in a manner that is least burdensome to providers and patients, the ACR said.
The full text of the bill can be found here.
