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

What Appropriate Use Criteria (AUC) content is used in CareSelect Imaging Open Access portal and why?

The Open Access portal uses content from the American College of Radiology (ACR), Society of Pediatric Radiology (SPR), American College of Cardiology (ACC), National Comprehensive Cancer Network (NCCN), and Society of Nuclear Medicine and Molecular Imaging (SNMMI). All qPLE (qualified Provider Led Entity) content sources are used as a condensed list of services to provide the most robust AUC content possible. The Open Access portal presents the most recent version of the CareSelect Imaging content.

Why do I need to provide my NPI at the time of self-registration?

This unique identifier will be necessary for planned future functionality allowing for proxy workflows (i.e. clinical staff members consulting AUC under the direction of an ordering provider) and aggregated reporting for a given provider’s consultations.

What are the acknowledgement reasons I see when I proceed with a consultation that has an inappropriate score?

Acknowledgement reasons allow you, as the ordering provider, to specify more details as to why the selected AUC is the best option for the patient even if it displays as inappropriate. We understand that certain scenarios are more complex than others and provide this functionality to allow for the documentation of those instances. This information can be seen on the Consultation Confirmation display, and your dashboard.

What type of reporting will I receive by using CareSelect Open Access?

You will be able to view all your CDS consultations in an aggregate view on the Open Access dashboard.

What happens if my password expires and/or I get locked out of the Open Access portal?

You will be able to use “I forgot my password” to re-set your password. If you do not log into the Open Access portal for an extended period (90 days), your account will be deactivated. When this happens, you will be prompted to reactivate your account at the time of login by providing the email address for the account, and following a link provided in a received email.

How do I work with my staff to have them act as my proxies?

Your clinical staff can act as ordering proxies under your direction. Future functionality of the Open Access portal will allow proxy users to associate CDS consultations with an ordering provider’s NPI.

Why shouldn’t my entire office register under one login account for CareSelect Open Access?

Maintaining separate Open Access accounts will allow for CDS consultations to be appropriately aggregated and provide the ability to distinguish CDS consultations by ordering provider.