EvidenceCare approved by CMS as qualified clinical decision support mechanism

July 16, 2019

Nashville-based clinical revenue cycle optimization tool EvidenceCare announced it is officially approved by the Centers for Medicare and Medicaid Services (CMS) as a qualified clinical decision support mechanism under the Medicare Appropriate Use Criteria program for advanced diagnostic imaging.

The company says the qualification comes in anticipation of the new diagnostic imaging ordering requirements placed on providers for Medicare beneficiaries by the Protecting Access to Medicare Act of 2014 (PAMA).

When looking to order an advanced diagnostic imaging service for a Medicare beneficiary, a provider or her team will need to consult appropriate use criteria stored in a qualified clinical decision support mechanism to help them determine if the criteria for ordering the imaging service is met. If the criteria are not consulted and proof of met criteria is not documented, claims for the diagnostic services will likely be denied. These requirements are set to go into effect in any facility where diagnostic imaging may be ordered by 2021, with the trial period for early adopters beginning in January of 2020.

In order to qualify, EvidenceCare was required to partner with a “provider-led entity” to develop the appropriate use criteria guidelines it stores in its clinical decision support tool. The company partnered with Intermountain Ventures, a department of Intermountain Healthcare in Salt Lake City, UT.

EvidenceCare was conceived by emergency medicine physician Brian Fengler in 2014 to solve a fundamental need of healthcare providers to be able to access evidence-based treatment recommendations within their clinical workflow that are patient-focused and that drive quality care, patient safety and reduced care variation.

Today the company partners with industry-leading organizations and medical societies to provide reliable and easy-to-access content to more than 5,000 providers in areas such as emergency medicine, gastroenterology, urgent care and antibiotic stewardship.

Fred Marheine, EvidenceCare’s vice president of operations who led the CMS qualification process, said the company is excited about what this means for clinicians using their tool.

“Achieving CMS qualification enables EvidenceCare users to apply the most current, evidence-based guidelines in developing treatment options while simultaneously ensuring mandatory AUC are met, all while saving time, dramatically enhancing documentation, and improving reimbursements by ensuring compliance and reducing errors,” Marheine said.

EvidenceCare is officially qualified through June 2024 and will undergo a re-validation process every five years, in accordance with CMS requirements.