2020 Update: Referring Provider Requirements When Ordering Diagnostic Imaging Tests

Getting your patients the Medicare diagnostic imaging tests they need just got more difficult. Medicare kicked off its imaging Clinical Decision Support (CDS) mandate in 2020, which means more work for you.

Don’t make the mistake of thinking that CDS only affects those practices that are actually performing and billing for the Medicare diagnostic imaging tests. As the practice ordering the test, you must consult Medicare’s Clinical Decision Support Mechanism (CDSM) tool to determine if your order adheres to the new guidelines.

Failing to correctly include Appropriate Use Criteria (AUC) with your diagnostic test order will mean the test will most likely NOT be performed. Also, you don’t want to be identified as an outlier by Medicare, because that means that you’ll be required to get any diagnostic imaging test you order preauthorized (not a pleasant thought).

Your ability to correctly utilize Medicare’s CDSM tool and accurately apply AUC with your diagnostic test order is imperative.

To help you navigate this new rule more effectively, expert Lee Williams, RHIA, CCS, CCDS, CPC, CPCO, CEMC, CHONC, CRC, has put together  a step-by-step online training.

Here are just a few of the practical Medicare diagnostic imaging Tests tactics you’ll receive during this 60-minute online training:

  • Halt confusion between “voluntary” and “mandatory” reporting time
  • Accurately retrieve what you need from Medicare’s CDSM online tool
  • Avoid EHR problems from getting you into trouble
  • Pin down diagnostic settings that these rules apply to
  • Determine if you fit the exception and are not required to participate
  • Record your diagnostic tests to ensure a MIPS credit
  • And so much more…

There is some good news that comes with the added work you’ll be required to perform to meet these new Medicare diagnostic imaging guidelines. You can use the CDS consultation to earn credit under QPP Merit Based Incentive Payment System (MIPS).

There is no doubt that radiology providers will feel the reimbursement pain if you don’t accurately utilize Medicare’s new CDSM tool and correctly report the Medicare diagnostic imaging tests you order. But it’s your patients that will ultimately pay.

Don’t wait, register for this expert-led online training today.

Meet Your Expert

Leonta Williams

Leonta (Lee) Williams is currently the Director of Coding at a large physician organization in the southeast.  Lee has over 15 years of experience working in both the outpatient and inpatient setting.  Some of her professional roles have included coder, auditor, practice manager, educator, and trainer.

Lee has presented at national healthcare conferences, private healthcare training organizations, and has frequently contributed articles to healthcare publications.  She currently serves on a number of Boards including Georgia Health Information Management Association (GHIMA) and the American Academy of Professional Coders (AAPC).  Lee has a B.S. in Health Information Management and an MBA with concentration in Healthcare Administration.


The webinar was very well presented.
Carmen Davis
Director of Patient Accounting, Bond Clinic, PA
Very informative with good information.
Laken Pollock
HIM Director, Northeast MT Health Services
Well done!
Nashiely Rodriguez
Revenue Cycle Manager, Sonoma County Indian Health Project