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To date, the ICACTL is aware that the following insurers have adopted
computed tomography reimbursement directives, and provides this
information as a service to the CT community. If you are aware
of additional payment policies, please email Tamara Sloper.
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, have 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>>
MOUNTAIN STATE BLUE CROSS BLUE SHIELD
West Virginia and Washington County, Ohio
November 2007
Starting
in November of 2007, Mountain State Blue Cross Blue Shield (Mountain
State) will initiate credentialing criteria that pertains
to outpatient general computed tomography (CT) services and
cardiac computed tomography angiography (CCT-A) services.
Credentialing details may also be obtained by visiting the provider
tab of Mountain State's website at www.msbcbs.com.
Outpatient
CT Provider Types and Credentialing Criteria:
- Hospitals
that provide outpatient CT and/or CCT-A services
- Free
standing imaging facilities that provide outpatient CT and/or
CCT-A services
- Physician
offices that provide outpatient CT and/or CCT-A services
Accreditation:
A copy of a current letter or certificate of accreditation,
both of which will be inclusive of the accreditation expiration
date. Accepted accreditations are:
- The
American College of Radiology (ACR) for free standing and
physician office based outpatient CT scanners
- The Intersocietal Commission for the Accreditation of Computed
Tomography Laboratories (ICACTL) for free standing and
physician office based outpatient CT scanners
- The
Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) for hospital based outpatient CT scanners
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