Infinx CDSM Module
If you already use our artificial intelligence driven Prior Authorization Software, you are familiar with how easy it is to obtain timely preauthorizations from commercial payers. Our new CDSM Module can now help ensure you obtain certified compliance certificates for advanced imaging orders covered by public payers Medicare and Medicaid.
Currently, we are the only solution on the market conditionally approved by CMS that has developed a comprehensive CDSM solution specifically catering to imaging providers.
New CDSM Mandate
Starting January 1, 2020, physicians ordering specific advanced imaging tests for Medicare/Medicaid patients must confirm their treatment decision by consulting appropriate use criteria (“AUC”) with a Center for Medicare/Medicaid Services (“CMS”) approved electronic clinical decision support tool (“CDSM”) pursuant to the Protecting Access to Medicare Act (“PAMA”) passed in July 2014.
Proof of such consult must then be provided to the rendering physician who submits it to Medicare and Medicaid along with the claim for reimbursement after the imaging test is performed. In 2021, reimbursements will be withheld if it is determined that the ordering physician did not consult a CDSM tool before ordering the procedure.
How We Do It
Infinx CDSM Module Key Features:
Approved CDSM Tool
Our CDSM has preliminary qualification from CMS with plans to get fully qualified by December 2019. It will ensure full compliance to the CMS requirements of consultation and reporting as well as preauthorization.
High-Quality Clinical Decision
Provides ordering physicians with a high-quality clinical decision support experience with a rich library of AUCs sourced from Qualified Provider Lead Entities (QPLEs) like Sage Evidence-based Medicine & Practice Institute (SEMPI).
Recommendations For Appropriate Procedures
After accepting patient details, the software follows a simple flow and generates the “compliance certificate” that will ensure compliance.
Coverage Of All Priority Clinical Areas
Specialties include coronary artery disease (suspected or diagnosed), suspected pulmonary embolism, headache (traumatic and nontraumatic), hip pain, low back pain, shoulder pain (to include suspected rotator cuff injury), cancer of the lung (primary or metastatic, suspected or diagnosed).
Provides immediate access to current patient information for both furnishing and ordering physicians.
Extension of Infinx Prior
Seamlessly connects with our artificial intelligence driven prior authorization solution to cover imaging orders by public payers.
Benefits To Your Organization
One solution for managing CDSM requests for Medicare orders and prior authorizations for commercial payer orders.
Ability to support all referring physicians without complex integration into their EMR systems.
Identify all Medicare orders that will require a CDSM consult.
Ability to request a CDSM consult even if it was missed at order creation.
A single repository of all your CDSM request and consult certificates for CMS reporting.
Let Infinx help you preserve more revenue. Contact us today to
learn more about our prior authorization software.