Clinical Decision Support

A Clinical Decision Support Mechanism (CDSM) is an interactive, electronic tool for use by clinicians that communicates appropriate use criteria information to the user and assists them in making the most appropriate treatment decision for a patient’s specific condition.

RIMI has provided a Clinical Decision Support Mechanism (CDSM) called Care Select for our referring providers to access. Click here for the link.

To register as a Care Select User: To access the Care Select Imaging Open Access Portal for the first time, navigate to http://openaccess.careselect.org/registration and register for an account. To register, you will need to provide basic information, including your name, NPI, email, etc. Once your registration is complete, you will be able to log into the application.

To access Care Select after you’ve registered: Navigate to http://openaccess.careselect.org and enter your username and password created during your initial registration.

Additional information:
– For further instruction, the User Guide and Frequently Asked Questions (FAQS) documents can be found on Care Select Portal after login.
– Google Chrome needs to be used when accessing Care Select.

Yes, referring providers must consult Appropriate Use Criteria for patients with Medicare Part B and Railroad Medicare listed as secondary insurance.

Yes, all medical providers that order imaging exams for patients that have Medicare Part B and Railroad Medicare as either primary or secondary insurance must comply with the AUC Mandate unless they qualify for a hardship. Hardships are: insufficient internet access, electronic Medical Records or CDSM issues or extreme and uncontrollable circumstances.

All CT and MRI exams ordered by a medical provider for patients that have primary or secondary Medicare Part B and Railroad Medicare insurance.

No, the mandate does not apply to Senior Managed Insurance Plans.

No, Rhode Island Medical Imaging will refuse Medicare Part B and Railroad Medicare referred patients without the proper AUC documentation, as stated in the Appropriate Use Criteria Mandate.

The Clinical Decision Support Mechanism, Care Select, that RIMI has provided will ask for the patient’s age and sex. You will also have to provide information about the patient’s signs and symptoms as well as the test being ordered. You may be required to answer additional clinical questions in order to complete the request. Based on what is entered, an appropriateness score will be generated.

No, the law and regulations are clear that the Appropriate Use Criteria consultation must be performed by the referring provider’s office.

As the ordering professional, you may delegate the Appropriate Use Criteria consultation to clinical staff acting under your direction if you do not personally perform the Appropriate Use Criteria consultation yourself.

Patients that present with an emergent condition are exempt from AUC. To qualify for an emergency exemption, the clinician only needs to determine that the medical condition manifests itself by acute symptoms of sufficient severity (including severe pain) such that absence of immediate medical attention could reasonably be expected to result in: placing the health of the individual (or a woman’s unborn child) in serious jeopardy; serious impairment to bodily functions; or serious dysfunction to any bodily organ or part.

The referring provider is responsible for providing the Appropriate Use Criteria consultation information to Rhode Island Medical Imaging as part of the order by electronically or manually writing it on the patient’s referral slip.

The referring provider will need to provide the name of the Clinical Decision Support Mechanism used and whether the result of the consultation was “adhere”, “not adhere”, or “not applicable.” A series of G codes will represent the CDSM used by the ordering provider and modifiers will represent the outcome of the Appropriate Use Criteria.

See below:

G1001 – Clinical Decision Support Mechanism eviCore, as defined by the Medicare Appropriate Use Criteria Program

G1002 – Clinical Decision Support Mechanism MedCurrent, as defined by the Medicare Appropriate Use Criteria Program

G1003 – Clinical Decision Support Mechanism Medicalis, as defined by the Medicare Appropriate Use Criteria Program

G1004 – Clinical Decision Support Mechanism National Decision Support Company CareSelectTM*, as defined by the Medicare Appropriate Use Criteria Program

G1007 – Clinical Decision Support Mechanism AIM Specialty Health, as defined by the Medicare Appropriate Use Criteria Program

G1008 – Clinical Decision Support Mechanism Cranberry Peak, as defined by the Medicare Appropriate Use Criteria Program

G1009 – Clinical Decision Support Mechanism Sage Health Management Solutions, as defined by the Medicare Appropriate Use Criteria Program

G1010 – Clinical Decision Support Mechanism Stanson, as defined by the Medicare Appropriate Use Criteria Program

G1012 – Clinical Decision Support Mechanism AgileMD, as defined by the Medicare Appropriate Use Criteria Program

G1013 – Clinical Decision Support Mechanism EvidenceCare’s Imaging Advisor, as defined by the Medicare Appropriate Use Criteria Program

G1014 – Clinical Decision Support Mechanism InveniQA’s Semantic Answers in Medicine, as defined by the Medicare Appropriate Use Criteria Program

G1015 – Clinical Decision Support Mechanism Reliant Medical Group, as defined by the Medicare Appropriate Use Criteria Program

G1016 – Clinical Decision Support Mechanism Speed of Care, as defined by the Medicare Appropriate Use Criteria Program

G1017 – Clinical Decision Support Mechanism HealthHelp, as defined by the Medicare Appropriate Use Criteria Program

G1018 – Clinical Decision Support Mechanism INFINX, as defined by the Medicare Appropriate Use Criteria Program

G1019 – Clinical Decision Support Mechanism LogicNets, as defined by the Medicare Appropriate Use Criteria Program

G1020 – Clinical Decision Support Mechanism Curbside Clinical Augmented Workflow, as defined by the Medicare Appropriate Use Criteria Program

G1021 – Clinical Decision Support Mechanism E*HealthLine, as defined by the Medicare Appropriate Use Criteria Program

G1022 – Clinical Decision Support Mechanism Intermountain, as defined by the Medicare Appropriate Use Criteria Program

G1023 – Clinical Decision Support Mechanism Persivia, as defined by the Medicare Appropriate Use Criteria Program

See below:

MA – Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition

MB – Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access

MC – Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues

MD – Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances

ME – The order for this service adheres to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional

MF – The order for this service does not adhere to the appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional

MG – The order for this service does not have appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional

MH – Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider

No, the imaging facility will not be able to use a reverse look up to obtain the AUC information.

• AgileMD’s Clinical Decision Support Mechanism
• AIM Specialty Health ProviderPortal
• Cranberry Peak ezCDS
• Curbside Clinical Augmented Workflow
• E*HealthLine CDSM
• Evicore Healthcare’s Clinical Decision Support Mechanism
• EvidenceCare’s Imaging Advisor
• HealthHelp CDSM
• INFINX CDSM
• Intermountain CDSM
• Inveni-QA’s Semantic Answers in Medicine
• LogicNets AUC Solution
• MedCurrent OrderWise TM
• Medicalis Clinical Decision Support Mechanism
• National Decision Support Company CareSelect
• National Imaging Associates RadMD
• Persivia Clinical Decision Support
• Reliant Medical Group CDSM
• Sage Health Management Solutions Inc. RadWise
• Speed of Care CDSM
• Stanson Health’s Stanson CDS

• Aim Specialty Health Provider Portal
• National Decision Support Company Care Select
• Test Appropriate CDSM

Yes, there will be a Clinical Decision Support Mechanism Link on the rimirad.com website for our referring providers to access.
 

Please visit www.acr.org/cds for more information.

Please contact your RIMI Marketing Representative with any questions or concerns that you may have or you can email marketing@rimirad.com for further assistance.