www.icamrl.org

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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