Epic1 PAMA Updates:

PAMA Update for Epic1.org: March 2022

In November, CMS updated the timing of the Protecting Access to Medicare Act (PAMA) payment penalties. CMS will no longer pay technical or professional claims for Advanced Imaging unless they have documented use of Clinical Decision Support with Appropriate Use Codes (AUC). At this time the penalties will go live the January 1st after the COVID Public Health Emergency is declared over. Therefore, if the PHE is declared over this spring (2022) as expected, the penalty phase will start 1/1/2023.

BJC is preparing to go live with AUC coding of all Advanced Imaging Exams this Fall, well in advance of this deadline. At that time, all outpatient Advanced Imaging orders will require AUC codes be provided at the time the order is placed. Patients will not be scheduled without an order. This includes Emergency and Observation patients. Orders without the codes will be invalid orders and returned to the ordering provider for AUC coding. BJC is prohibited under this CMS Rule from adding the codes on behalf of the provider.

Options for OUTPATIENT ordering providers:

  1. If you have access to the BJC/WU Epic platform, enter the order directly in Epic. The Clinical Decision Support and coding are built in.

  2. If you do not have Epic in your practice and would like BJC/WU EpicCare Link access to place orders, contact the EpicCare Link Team at https://www.myepiccarelink.org.

  3. FAX or paper orders without AUC Codes will be returned to the provider as invalid orders for completion.

  4. Telephone orders without codes cannot be accepted; please have the codes available when you call.

  5. Online webservices are available for PAMA AUC coding.