Care Select

2020 New Imaging Requirements

PAMA Requirements for Medicare Patients

Protecting Access to Medicare Act (PAMA) established a new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. Examples of services include:

• Computed tomography (CT)
• Positron emission tomography (PET)
• Nuclear medicine
• Magnetic resonance imaging (MRI)

Guidelines require that all providers placing orders for these services for Medicare patients are required to consult a qualified Clinical Decision Support Mechanism (CDSM) to ensure the test  being ordered meets appropriate use criteria (AUC). Woman’s has chosen the Care Select CDSM due to its integration with Meditech. 

IMPORTANT DATES: 

• January 1, 2020: All providers are asked to begin following this policy.
• April 1, 2020: Patients without proper authorization through the CDSM will not be tested until authorization is received. 

POINTS TO REMEMBER:

• This is ONLY for Medicare patients.
• This is an ADDITIONAL step to insurance authorization. You must do both steps.
• The law does not mandate you strictly adhere to the AUC, just consult the AUC. Unlike prior authorization, there is no “hard stop.”

Creating your Care Select Account

Providers must first create an account by going to openaccess.careselect.org/registration and provide basic information, including your name, your individual NPI, email, etc.

Accessing Your Care Select Account

If you are on Meditech, Care Select will automatically appear on screen when placing these orders.

If you are NOT on Meditech, you will have to go to Care Select’s authorization portal when placing orders for these patients. You can access this at openaccess.careselect.org.

To receive authorization through Care Select:

• Enter patient’s age, sex and service being ordered.
• Select the appropriate indication.
• Select a service from the available options.
• Record the following numbers needed to place the order:

• HCPCS Code (G Code)
• HCPCS Modifier (M Code)
• Decision Support Number
• Appropriateness Score

• Place your order accompanied by the above numbers and codes.

Download the CareSelect Imaging Open Access User Guide [PDF] for detailed step-by-step instructions on how to create and access your Care Select account and receive the necessary codes.

Support

Pat Guilbeau, Information Technology
225-924-8303 or patricia.guilbeau@womans.org
Cynthia Rabalais, Imaging
225-924-8264
Trivinia Toussant, Clinical Infomatics
225-924-8949

FAQs