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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 MR 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. If you are aware of additional payment policies, or have questions about the information posted, please e-mail Tamara Sloper, Marketing Director.


IAC RECEIVES DESIGNATION BY CMS AS ACCREDITING ORGANIZATION FOR MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT (MIPPA)

NEWLY UPDATED, JANUARY 26, 2010 | As part of the Medicare Improvements for Patients and Providers Act (MIPPA), by January 1, 2012, all nonhospital providers of advanced diagnostic imaging, inclusive of Nuclear Medicine, MR, CT and PET, must obtain accreditation as a condition for reimbursement. The Intersocietal Accreditation Commission (IAC) has been approved by the Centers for Medicare & Medicaid Services (CMS) to accredit suppliers seeking to furnish the technical component (TC) of advanced diagnostic imaging services under the Medicare program.
Read more in IAC Accreditation in the News >>

OR

Download the news release >>



MORE INFORMATION ON MIPPA:



ANTHEM HEALTH PLANS OF VIRGINIA, INC. d/b/a
Anthem Blue Cross and Blue Shield and its HMO Affiliates

(VIRGINIA)
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.



UNITEDHEALTHCARE

NEWLY UPDATED, 12/30/09 | UnitedHealth Group (UnitedHealthcare) has released an announcement stating: “UnitedHealthcare is committed to ensuring that all of our members have access to quality health care, including medical imaging services. We believe patients deserve assurance that equipment, technologists and physician practices are in compliance with professional society-developed performance standards for CT, MRI, PET, nuclear medicine/cardiology and echocardiography procedures. As previously announced, UnitedHealthcare will require accreditation as a condition of eligibility for reimbursement for these imaging services. Further, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) will require providers of advanced imaging services (CT, MRI, PET, nuclear medicine) to be accredited by January 1, 2012. Effective this date, accreditation will become a mandatory requirement in order to receive payment from Medicare for the technical component of imaging services. We are awaiting the final CMS publication that will describe their operational criteria, which we will review and consult with the accrediting agencies to determine if modifications are needed for our program to ensure alignment. As we strive to achieve operational consistency and effectiveness when new programs are introduced, UnitedHealthcare will not activate the claim denial component of the imaging accreditation program until further notice. We will communicate the new effective date, via formal letters, 90-days in advance of the activation. We will also communicate additional information about this program through the physician portal, UnitedHealthcare Online, and in future issues of the Network Bulletin. We remain committed to advancing the quality and safety of imaging services through the Imaging Accreditation Program and will keep you apprised of our revised implementation time frame. In the interim, we encourage you to continue your preparedness activities.”

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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