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To
date, the ICAMRL is aware that the following insurers or companies
have adopted magnetic resonance reimbursement directives. While
the ICAMRL attempts to stay abreast of reimbursement policies
as a service to the magnetic resonance community, these policies
are changed and updated regularly by the insurance carriers.
Therefore, the ICAMRL recommends that you contact the insurance
carriers in your area for the most accurate and current information.
(These numbers are available through your hospital or laboratory's
billing department.) If you are aware of additional payment
policies, or have questions about the information posted, please
e-mail Lawrence
Williams, Marketing Specialist.
Anthem
Health Plans Of Virginia, Inc. d/b/a Anthem Blue Cross and
Blue Shield and its HMO Affiliates (Virginia)
April 2008
APRIL
2008 - Anthem Health Plans of Virginia, Inc. d/b/a Anthem
Blue Cross and Blue Shield and its HMO affiliates, released
the following announcement:
- Accreditation
requirements included to promote consistent, quality diagnostic
imaging services
- Standards
set by appropriate societal organizations have been adopted
and will be utilized to establish a certification process
for all imaging providers.
- Participating
provider currently performing or conducting any CT, CTA, MRI,
MRA, MRS, PET and/or Nuclear/Nuclear Cardiology studies shall
obtain accreditation from the American College of Radiology
(ACR) or Intersocietal Accreditation Commission (IAC) within
one year of the effective date of this Agreement. Accreditation
is required for each piece of equipment utilized in such studies
no later than April 1, 2009.
- Participating
provider not currently performing any CT. CTA, MRI, MRA, MRS,
PET and/or Nuclear/Nuclear Cardiology studies, but at any
point purchases or leases equipment and begins performing
such studies, participating provider shall obtain accreditation
from the American College of Radiology (ACR) or Intersocietal
Accreditation Commission (IAC) for each piece of equipment
utilized in such studies within one year of the date such
studies are first conducted.
- Additional
communication will follow on diagnostic imaging services,
equipment, licensure and/or accreditation.
DIAGNOSTIC
IMAGING SERVICES
Within
30 days of receipt of a written request, participating provider
shall provide to Health Plan such information as may be requested
concerning diagnostic imaging services, equipment, licensure
and/or accreditation.
Providers
that perform or conduct any CT, CTA, MRI, MRA, MRS, PET and/or
Nuclear/Nuclear Cardiology studies shall be accredited by
the American College of Radiology (ACR) or Intersocietal Accreditation
Commission (IAC) for each piece of equipment utilized in such
studies.
United
Healthcare
January 2007; revised 1/15/2008
NEWLY
UPDATED, 1/15/2008
- UnitedHealth Group (UnitedHealthcare) has released an announcement
requiring all freestanding imaging facilities and physician
offices performing magnetic resonance procedures to apply
for accreditation, and has extended
its original deadline (3/1/2008) for this requirement until
the third quarter of 2008.
Please note: UnitedHealthcare has stated that freestanding
imaging sites and/or provider clinics with imaging equipment
who have not received accreditation by the above deadline,
but have submitted their application to the ICAMRL, will be
in a pending status and will be considered in compliance with
the accreditation program.
Would
you like to know more about the UnitedHealthcare requirement?
For the details and official guidelines from UnitedHealthcare,
please visit their website section for Imaging
Accreditation. [Go to UnitedHealthcareOnline.com
> Clinician Resources > Radiology, and
select Imaging Accreditation from the vertical menu
bar on the left.] Get answers to common questions about the
UnitedHealthcare policy in Imaging
Accreditation: Frequently Asked Questions. >>
Anthem
Blue Cross Blue Shield (Indiana, Kentucky, Ohio)
June 2006
Community
Insurance Company d/b/a Anthem Blue Cross and Blue Shield
in Ohio, Anthem Health Plans of Kentucky, Inc. d/b/a Anthem
Blue Cross and Blue Shield in Kentucky, and Anthem Insurance
Companies, Inc. d/b/a Anthem Blue Cross and Blue Shield in
Indiana now accepts Intersocietal Commission for the Accreditation
of Nuclear Medicine Laboratories (ICANL) from providers delivering
nuclear cardiology, nuclear medicine and PET imaging services.
In addition they accept Intersocietal Commission for the Accreditation
of Magnetic Resonance Laboratories (ICAMRL) from providers
delivering MRI services.
Blue
Cross Blue Shield of Kansas City
From the March 2006 Press Release
MARCH
6, 2006 -- Blue Cross Blue Shield of Kansas City (BCBSKC)
has introduced a radiology privileging criteria program to
practitioner groups within its service area, stating that
"criteria implementation at all practitioner group sites
will enhance service quality and safety of the diagnostic
imaging studies delivered to our members and your patients."
The
objective of BCBSKC's privileging program is to "facilitate
and promote an interrelated group of operational and professional
criteria to ensure that practitioner groups providing CT,
MR, plain film and PET services to membership are equipped
and proficient to extend quality-driven service, technologically
sound delivery and expertise within a safe and efficient environment."
Practices
will be required to successfully complete the privileging
program in order to continue providing imaging services to
the BCBSKC PPO and HMO membership. BCBSKC has retained National
Imaging Associates (NIA), a radiology management company,
to function as the BCBSKC privileging program administrator
and education consultant.
Guidelines
Specific for CT/MR:
- CT/MR
must be performed at a practice site that provides at least
three (3) radiology modalities (list of eligible modalities
attached)
- Offer
diagnostic imaging services to patients during practitioner's
office hours
- Staffed
on-site by a BCBSKC credentialed practitioner, board-certified
within a specialty whose scope and expertise is related
to the study being performed and interpreted. Alternatively,
staffed on-site by a BCBSKC credentialed radiologist at
any time contrast is administered; or at all other times,
a BCBSKC credentialed radiologist should be no more than
ten (10) minutes from the practice site in the event he/she
must personally assist in the procedure or to assume the
primary care of the patient. Any and all eligible credentialed
practitioner participating in CT/MR delivery must have current
Advanced Cardiac Life Support (ACLS) or Advanced Radiology
Life Support (ARLS) certification.
- Employ
certified technologists (AART or other state recognized
certification or licensure)
- MRA
capability must be available if offering MRI services
- Achieve
accreditation by the American College of Radiology (ACR)
or the Intersocietal Accreditation Commission (IAC), as
available, within one (1) year of BCBSKC privileging
- Practitioner
must submit evidence of accreditation application within
three (3) months of BCBSKC privileging
Recommendations
As stated by the
AMERICAN COLLEGE OF CARDIOLOGY (ACC)
Adopted by the ACC Board Of Trustees, March 5, 2005
"The
American College of Cardiology (ACC) is a leader in the promotion
for high quality cardiovascular care. The mission of the ACC
is to advocate for quality cardiovascular care through education,
research promotion, development and application of standards
and guidelines, and to influence health care policy.
To
improve health care quality, the ACC strongly supports participation
in physician certification and/or laboratory accreditation
programs developed by physicians and appropriate to the field
of practice. Certification and accreditation programs clearly
have a role in quality improvement by providing independent
evaluation and validation of performance of providers and
facilities.
To
achieve improved clinical performance and quality, the ACC
encourages all providers to implement and utilize quality
measurement and improvement tools, combined with outcomes
data monitoring in all settings. The ACC strongly encourages
adherence to ACC clinical practice guidelines and expert consensus
documents that translate evidence-based medicine into clinical
practice. The ACC also promotes the use of clinical competency
statements and adherence to Core Cardiology Training Symposium
(COCATS) recommendations where competency guidelines do not
exist. Accreditation/certification programs provide a convenient
means for meeting these criteria.
The
ACC encourages governments and payers to make accreditation/certification
programs mandatory conditions of participation.
In implementing such requirements, ACC encourages a gradual
approach to ensure a realistic timetable for compliance which
minimizes economic impact on current practitioners. Exceptions
to mandates may be necessary to ensure that patients have
access to care in underserved areas.
The
American College of Cardiology Foundation (ACCF) produces
the following quality improvement tools that can assist physicians
and other cardiovascular care providers to analyze their performance
and participate in a continuous quality improvement process:
- Guidelines
Applied in Practice (GAP), customizable tools to improve
adherence to evidence-based guidelines
- The
National Cardiovascular Data Registry (NCDR), which provides
participants with standardized data elements and definitions
and quarterly comparative reports on the safety and effectiveness
of cardiac catheterization (and soon, electrophysiology
and carotid stenting) procedures
- CathKIT,
a tool for use in improving the performance of cardiac catheterization
laboratories through self-assessment and evaluation to effectively
and efficiently improve quality and outcomes of care.
The
ACCF has also been a partner in developing Intersocietal Accreditation
Commission programs for vascular, nuclear, echocardiography,
and magnetic resonance imaging laboratories."
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