Record AUC Data on Diagnostic Procedures
The Diagnostics tab supports AUC verification. If the patient's insurance carrier or other payer details change, you must re-order the radiology tests after the payer modification is documented.
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NextGen® Adaptive Content Engine Help Enterprise 8
If an advanced imaging order meets the appropriate use criteria (AUC), the My Custom Plan template saves the following information: the name of the qualified Clinical Decision Support Mechanism (CDSM) vendor, the ordering provider's National Provider Identification (NPI), the AUC score and the time the AUC was run, the reference number, the order date, and the G code and modifier. The captured information prints on the requisition document. If the advanced imaging order does not meet the AUC (for example, an AUC score of less than three), you can do the following: Accept the score and proceed. If the configuration for AUC certification is set up correctly, you cannot proceed without accepting the AUC score. If you cancel the score wizard, the order is not added to the pending orders grid and must be reordered. Cancel the current order and return to the My Custom Plan or Diagnostic Procedures template to reorder the identified advanced imaging test. Look at the other tests that are dispAppropriate Use Criteria (AUC) Validation on an Advanced Imaging Order
NextGen® Adaptive Content Engine Help Enterprise 8
The AUC score is used to validate the appropriateness of an Advanced Imaging order. You can initiate the American College of Radiology (ACR) Appropriate Use Criteria (AUC) score wizard from the Assessment And Plan or Procedure Order cardiology templates by selecting a radiology order or cardiology procedure such as a CT, MRI, PET, Echo, or ECG. The AUC wizard displays the AUC score, which indicates whether the selected order is the most appropriate imaging test for a specific clinical condition or not. You can either accept or cancel the AUC score. If you accept the AUC score, the Assessment And Plan or the Procedure Order template records the AUC score and prints it on the requisition document. After the order is placed, the AUC score label no longer appears on the Assessment And Plan and Procedure Order cardiology templates. The AUC information may be shared as order details when the cardiology procedure or radiology order is processed by a third party. For more information on the AUAUC Validation on Advanced Imaging Orders
NextGen® Adaptive Content Engine Help Enterprise 8
Configure AUC Scores Configure AUC Scores You must configure settings in File Maintenance and on the Practice Configuration practice template to use the AUC score wizard. To successfully use the AUC score wizard, you must configure the following settings in File Maintenance. Open NextGen® Enterprise EHR. To activate the AUC rules for the assigned payer, in the File Maintenance, do the following. In the Master Files, click Payers. The Payers List window opens. Double click a payer from the list. The Modify Payer Information window for the payer opens. Click the Orders Module tab, and select the Enable payer for Appropriate Use Criteria rules for Advanced Radiology Imaging orders check box. Apply the AUC for all payers within the same financial class, if necessary. To automate the inclusion of modifier and G-code in the procedure billing, select the Include AUC /HCPCS code modifier automatically option. Select a payer in the encounter level insurance for the current patient. In the OrderConfigure AUC Scores
NextGen® Adaptive Content Engine Help Enterprise 8
You can generate the Appropriate Use Criteria (AUC) for diagnostic tests. Before you begin You must configure the AUC in File Maintenance and map them in the Care Guidelines Setup practice template for a patient to generate an AUC score for an advanced imaging test and then place the appropriate order. In the Practice Configuration practice template, you must ensure that the Enable Appropriate Use Criteria (AUC) Rules check box is selected and the Enable Order Module check box is not selected. Open NextGen® Enterprise EHR. On a patient encounter, open any of the standard visit templates (for example, the Intake) template. On the template header, select the Care Guidelines link. The Care Guidelines Paged View template opens. In the Care Guidelines grid, select a diagnostic test. The AUC Score Wizard opens. Select the check boxes for exam indications and then select Review AUC. AUC Score Wizard The AUC Score Wizard displays the AUC score for the selected test. Review the AUC score generaOrder Diagnostic Tests by AUC Score
NextGen® Enterprise EHR Help
Before you begin Ensure that you have configured Appropriate Use Criteria (AUC) in File Maintenance. For more information on how to configure AUC, go to NextGen Healthcare Success Community and download the latest Radiology Appropriate Use Criteria Workflow for the Orders Module for NextGen® Enterprise EHR. Ensure that you have selected the insurance information for the patient in the All tab. Note: Computerized Physician Order Entry (CPOE) derives the insurance and diagnosis settings from the Preferences configuration in Practices in File Maintenance. For more information, go to NextGen Healthcare Success Community and download the latest File Maintenance Preferences Guide for NextGen® Enterprise. Ensure that you have completed the charge submission and payers information configurations in File Maintenance, which enables your practice to post charges for performing laboratory and diagnostic tests, and also to automatically include Healthcare Common Procedural Coding System (HCPCS) codPerform AUC Check
NextGen® Enterprise EHR Help
To meet the regulatory CMS mandate for Clinical Decision Support (CDS) when ordering radiology advanced imaging tests (such as CTs, MRIs, and PET scans), practices can set up and use Appropriate Use Criteria (AUC). After setting up the AUC in File Maintenance, providers or other clinical staff can order Advanced Imaging tests and receive appropriate use feedback for a patient’s medical condition before placing radiology orders from the Orders module. This process occurs immediately after the user selects the advanced imaging test on the Create New Radiology Order window. For detailed information on setting up and using Appropriate Use Criteria (AUC), go to the NextGen Healthcare Success Community, and download the Radiology Appropriate Use Criteria Workflow for the Orders Module for NextGen® Enterprise EHR. Parent topic: Create a Radiology Order Workflow