Clinical Decision Support Mechanism (CDSM) Solution
Ensure imaging procedures you perform will get
reimbursed by Medicare.
Infinx CDSM Solution
If you already use our artificial intelligence driven Prior Authorization Software, you are familiar with how easy it is to obtain timely prior authorization from commercial payers. Our new Clinical Decision Support Mechanism (CDSM) solution can now help ensure you obtain certified compliance certificates for advanced imaging orders covered by Medicare.
Currently, we are the only CMS-approved solution on the market that has developed a comprehensive CDSM solution that can be integrated with our Prior Authorization Software.
New CDSM Mandate
Starting January 1, 2023, physicians ordering specific advanced imaging tests for Medicare patients must confirm their treatment decision by consulting appropriate use criteria (“AUC”) with a Center for Medicare 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 along with the claim for reimbursement after the imaging test is performed. 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 Solution Key Features:
Approved CDSM Tool
Our CDSM Solution received CMS-approval as of December 20, 2019. We ensure full compliance to the CMS requirements of consultation and reporting, including prior authorizations.
High-Quality Clinical Decision
Support Experience
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).
Clinical Dashboard
Provides immediate access to current patient information for both furnishing and ordering physicians.
Extension of Infinx Prior
Authorization Software
Seamlessly connects with our artificial intelligence driven prior authorization solution to cover imaging orders by Medicare.
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/EHR/RIS 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.
