Originally Published MD&DI September 2009
News Trends
Appropriateness Criteria for Imaging
The Medicare Improvements for Patients and Providers Act of 2008 established a two-year project to assess the appropriate use of diagnostic imaging services. According to the law, the secretary of Health and Human Services must select a group of volunteer physicians for the project that represent a wide range of geographic areas, demographic characteristics, and practice settings. The law also states that the criteria the secretary selects to determine the appropriate use should
• Be developed or endorsed by a medical specialty society.
• Be developed in adherence to appropriateness principles developed by a consensus organization.
Among the issues that the law instructs the project to evaluate are
• Whether potential use of appropriateness criteria could have an effect on the volume of advanced diagnostic imaging services furnished.
• Whether expansion of the use of appropriateness criteria to a broader population of Medicare beneficiaries would be advisable.
• Whether there is potential for using methods (including financial incentives) to ensure compliance with such criteria.
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