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    New imaging clinical decision support (CDS) mandates are coming for Medicare providers. Understanding the Protecting Access to Medicare Act (P.L. 113-93) and the Medicare Imaging Demonstration (MID) project is crucial for compliance.

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    Area of Science:

    • Health policy
    • Medical informatics
    • Radiology workflow

    Background:

    • Legislative mandates, such as P.L. 113-93 (Protecting Access to Medicare Act of 2014), are driving significant changes in healthcare imaging workflows.
    • Organizations must understand the requirements for meeting these mandates, particularly concerning clinical decision support (CDS).
    • The Centers for Medicare & Medicaid Services (CMS) initiated the Medicare Imaging Demonstration (MID) project in 2009, providing valuable insights into imaging CDS.

    Purpose of the Study:

    • To inform organizations about upcoming changes in imaging workflow mandated by P.L. 113-93.
    • To highlight the importance of understanding the requirements for compliance with legislative mandates.
    • To present the findings of the Medicare Imaging Demonstration (MID) project as a guide for implementing imaging CDS.

    Main Methods:

    • Review of legislative mandates, specifically P.L. 113-93.
    • Analysis of the Medicare Imaging Demonstration (MID) project initiated by CMS.
    • Examination of the requirements for using approved imaging CDS mechanisms for claims submission.

    Main Results:

    • The use of imaging CDS will be mandatory for submitting claims to CMS starting January 1, 2017.
    • An approved mechanism by the Secretary of HHS must be utilized for imaging CDS.
    • Results from the imaging CDS must be included on claims submitted by imaging facilities.

    Conclusions:

    • Organizations must prepare for and adapt to mandated changes in imaging workflow.
    • Compliance with P.L. 113-93 requires a thorough understanding of imaging CDS requirements.
    • The MID project evaluation offers critical lessons for the successful implementation of imaging CDS in preparation for the 2017 deadline.