Do you believe the Ordering Provider should be required to perform the CDS consult as stated by PAMA and proposed by CMS? Others don’t and are working to dilute it. Here is how to let CMS know what you think.

Section 218 of the Protecting Access to Medicare Act of 2014 as well as CMS’s recently released Proposed Rule implementing the Act state that the “ordering professional must consult” the CDS system when ordering covered exams.  It does not say someone else, e.g., an imaging center where the exam is scheduled, may perform the consult on behalf of the ordering professional.

CDS works because of this feedback loop to the ordering provider.  Remove the feedback loop and CDS’s ability to inform and educate ordering professionals, and reduce inappropriate utilization, will be lost.

However, it appears that some, primarily, outpatient-focused imaging companies and supporting vendors seem to believe the language is ambiguous enough to allow them to perform the consult on behalf of the ordering professional, and are planning to do just that.  While it is difficult to impute their motivations for doing so, one of the motivations is almost certainly to be to obtain a competitive advantage over other facilities who interpret the law and regulations as meaning what it says – the consult can ONLY be performed by the ordering professional.

This is no small matter.  I encourage you to let CMS know what you think by submitting comments.  I included a draft set of comments supporting the ordering professional perform this duty for you to use, as well as explicit instructions for how to submit them, below.

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Request: I request that CMS include a statement specifically stating that the ordering professional of advanced imaging procedures required by the Act to perform the AUC consultation must perform the consultation and that this responsibility may not be delegated to another individual, third-party, or contracted agent.

Discussion: The Act and Proposed Rule seem unambiguous in their requirement that the ordering professional must perform the AUC consultation.  “Enacting properly” means having the ordering professional actually use the CDSM/AUC properly and not delegating this to another individual, contracted agent, or third-party.

PAMA and the 2018 Proposed Rule seems to require the ordering professional perform the consultation. Section 218 of the Protecting Access to Medicare Act of 2014 reads in part:  An ordering professional shall— ‘‘(i) consult with a qualified decision support mechanism.  The Act also defines the term “Ordering Professional: as “a physician (as defined in section 1861(r)) or a practitioner described in section 1842(b)(18)(C) who orders an applicable imaging service.”  The 2018 Proposed Rule reads, in part:  “We are proposing that ordering professionals must consult specified applicable AUC through qualified CDSMs for applicable imaging services furnished in an applicable setting, paid for under an applicable payment system and ordered on or after January 1, 2019.”  There are several more references in the Proposed Rule requiring AUC consultation by “ordering professionals.”

However, I am concerned that some imaging facilities believe it is possible to circumvent this requirement and perform the AUC consultation on behalf of the ordering professional, and are, in fact, preparing to do so.

If you intend for the ordering professional to perform the consultation as seemingly required by PAMA and the Proposed Rule, I urge you to include a discussion/statement in the Final Rule discussing this issue and clearly stating that the consultation must be performed by the ordering professional (unless an exception applies), and that this duty may not be delegated to another individual, contracted agent, or third-party.

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Instructions for submitting comments

Comments must be received at one of the addresses provided below, no later than 5 p.m. on September 11, 2017.

ADDRESSES: In commenting, please refer to file code CMS-1676-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.  You may submit comments by either (please choose only one):

  • Electronically. You may submit electronic comments on this regulation to . Follow the instructions for “submitting a comment.”


  • By regular mail. You may mail written comments to the following address ONLY:

Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1676-P,
P.O. Box 8016,
Baltimore, MD 21244-8013.

Please allow sufficient time for mailed comments to be received before the close of the comment period.


As always, Dose Registry Support Services is ready to help facilities with their Dose Registry submission processes and needs.  The DIR is not a set and forget program; it requires a little care and nurturing.  We also offer a very effective program (DoseID) to meet The Joint Commission’s dose incident identification requirement.  See our website for more information.

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