CMS AUC Billing Information Reporting Requirements
Overview
The LogicNets AUC CDSM Web Service includes a set of important billing and reimbursement and claim-related information in the results it returns with each consultation. This information includes:
- The CPT code for the advanced imaging service that was evaluated.
- The line item HCPCS modifier, which is a two-letter code that indicates the level of adherence to AUC or that records an exception to the requirement. For reimbursement filing, this value should be included on the Advanced Diagnostic Images Services claim line.
- The G-code, which is a five-digit, alphanumeric string indicating which qCDSM product (LogicNets, for example) was used for performing the AUC consultation. LogicNets’ CMS identifier is “G1019” and this is the value that will always be generated in the results package returned by our service. Note that CMS requires that claims reporting an HCPCS modifier of “ME”, “MF”, or “MG” on the Advanced Diagnostic Images Services claim line must additionally include the G-code on a separate claim line.
- The Unique Consultation ID (UCI) for recording and identifying the consultation of applicable AUC guideline(s) for the specific patient, advanced imaging order and clinical scenario submitted to the CDSM Service. The UCI is a 45-digit alphanumeric string that is used by the LogicNets AUC Solution to definitively reference a specific consult. It can be used at any time after a consult is complete to restore, review, and audit the consultation history record. Consult history records are retained for on-demand access within the AUC Solution in accordance with HIPAA for a minimum of 6 years.
Figure 1: Reimbursement information generated in the results for an example AUC consultation
The Centers for Medicare & Medicaid Services (CMS) has issued the following document which contains their official instructions on how this AUC information must be reported: https://www.cms.gov/files/document/se20002.pdf
Distributing Billing Information to the Furnishing Provider
Since AUC validation is typically performed by an ordering professional, a workflow step is typically required to take the results returned by the CDSM Web Service and make it available to the furnishing provider who is most likely to be submitting a claim form for reimbursement by CMS for the validated imaging service. When the CDSM Web Service is invoked by an EMR or RIS system, the results will be consumed by that service which can then make the information available for downstream processing. With the AUC Web Portal, there are several mechanisms available for distributing the results to the furnishing provider:
- The user can select and copy the displayed AUC consult results into their clipboard and switch to the workflow application where they process claims to paste the results into their appropriate input areas. Note that the line display for the UCI of each consult has a button that allows that field to be more easily copied into the clipboard
- The Web Portal allows a full AUC consult results report to be generated as a PDF accessed from the browser where it can be downloaded, printed or emailed to the furnishing provider
- The Web Portal allows provider users and their organizations to connect with furnishing organization users of the LogicNets AUC Web Portal, which is available to users at no charge. They can then have the system make their submitted AUC consult reports available to the furnishing provider users and those users can either print PDF results or copy the results into their local claims submission forms as described above.