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To date, the ICANL is aware that the following insurers or companies have adopted nuclear medicine/nuclear cardiology/PET reimbursement directives. While the ICANL attempts to stay abreast of reimbursement policies as a service to the nuclear medicine community, these policies are changed and updated regularly by the insurance carriers. Therefore, the ICANL 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 Marketing Director Tamara Sloper at reimbursement@intersocietal.org.
Medicare Improvements for Patients and Providers Act (MIPPA)
NUCLEAR MEDICINE/PET FACILITIES MUST OBTAIN ACCREDITATION BY JANUARY 1, 2012
JANUARY 2012 UPDATE | Even though the MIPPA deadline has passed, the IAC is here to help you gain accreditation and to be in compliance with CMS as soon as possible. The ICANL staff is continuing to oversee the processing and review of submitted applications and delay material as expeditiously as possible. The ICANL review process typically takes 12-16 weeks for complete applications and an additional 2-4 weeks for delay materials. ICANL is currently working as quickly as possible to make certain you are in compliance with CMS.
DECEMBER 2011 UPDATE | As the January 1, 2012 accreditation mandate quickly approaches, the ICANL staff will continue to oversee the processing and review of submitted applications as expeditiously as possible. However, the ICANL cannot guarantee a decision will be rendered by 1/1/12 to facilities that submitted their completed application after October 2011 as the ICANL review process typically takes 12-16 weeks. Facilities preparing to submit (or facilities that have not submitted) are urged to complete the submission process as soon as possible in order to avoid extended non-payment of claims by Medicare after 1/1/2012. To view some commonly asked questions regarding the MIPPA mandate, please visit www.intersocietal.org/icanl/main/gettingstarted_MIPPA.htm.
NOVEMBER 2011 UPDATE | For those facilities that provide Advanced Diagnostic Imaging [inclusive of Nuclear Medicine, MR, CT and PET]
as defined by the Centers for Medicare & Medicaid Services (CMS), that will be impacted by the upcoming
January 1, 2012 accreditation mandate for nonhospital suppliers, it is critical that you access your facility’s IAC
Online Accreditation account as soon as possible to enter and/or verify and update the
National Provider Identifier (NPI) data and/or Medicare enrollment numbers. CMS as well as other private
insurers will verify the accreditation status of a supplier only through data file transfers containing this information.
Failure to enter accurate identification data will result in nonpayment of Medicare claims after 1/1/2012.
For those facilities not impacted by the CMS mandate (Vascular and Echocardiography) but potentially affected by
other insurance mandates, it is also important to update this information in your IAC Online Accreditation account
as most private insurers now request verification of accreditation status via data file transfers.
The IAC recently released an update to its Online Accreditation application and enhanced the way in which it
collects and stores identification information, specifically NPI data and Medicare enrollment numbers for each
participating facility.
To view the full instructions of updating the NPI data or Medicare enrollment numbers, click here.
OCTOBER 2011 UPDATE | CMS Advanced Diagnostic Imaging Accreditation Statutory Requirement Clarification»
SEPTEMBER 2011 UPDATE | Specific to nonhospital facilities applying for accreditation with the intention of complying with the January 1, 2012 CMS accreditation mandate: As the January 1, 2012 accreditation mandate approaches, the IAC staff will continue to oversee the processing and review of submitted applications as expeditiously as possible. Facilities preparing to submit, and those that have recently submitted their Online Accreditation applications and are awaiting an accreditation decision, are urged to act promptly to allow their applications to progress through the review cycle without disruption.
JANUARY 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.
To view the official CMS accreditation requirements, download Accreditation Requirements for Suppliers of the Technical Component of Advanced Imaging»
For those accredited facilities making changes to their facility after January 1, 2012, CMS has provided the following guidelines for its provisional policy.
Download the CMS policy on Provisional Accreditation Status»
To download the published Federal Register containing the notice of CMS' approval of IAC for fulfillment of the accreditation requirement for advanced diagnostic imaging, please visit the Federal Register website at www.federalregister.gov, or download the Federal Register, Vol. 75, No. 16, Tues, January 26, 2010, Notices: Department of Health and Human Services | Centers for Medicare & Medicaid Services»
NIA Recognizes IAC Accreditation Programs For PET/Nuclear Cardiology
National Imaging Associates (NIA) recognizes the Intersocietal Accreditation Commission (IAC) accreditation programs for:
as acceptable imaging accreditations for fulfilling the NIA credentialing requirement that facilities be accredited by an approved accrediting body. The following information is copied from the NIA Imaging Provider Handbook.
Read complete details about NIA credentialing requirement»
Aetna Mid-America Region
(IA, IL, IN, KS, KY, MI, MN, MO, MT, ND, NE, OH, OK, SD, TX, WI, WY)
AETNA MID-AMERICA REQUIRES ACCREDITATION BY JANUARY 1, 2012 AS A CONDITION FOR REIMBURSEMENT
DECEMBER 2010 | Beginning January 1, 2012, Aetna will have new radiology accreditation requirements for its commercial business. Please note: This policy does not apply to Medicare.
To be eligible for reimbursement for the technical component of advanced diagnostic imaging procedures, the following types of providers must be accredited by the Intersocietal Accreditation Commission (IAC) and/or the American College of Radiology (ACR): Independent diagnostic testing facilities; freestanding imaging centers; office-based imaging facilities; physicians; on-physician practitioners; suppliers of advanced diagnostic imaging procedures.
View
the full announcement, requirements for Aetna Mid-America»
CareCore National
MAY 2010 | For CT, MRI, Nuclear Medicine, and Ultrasound equipment, accreditation by appropriate national organizations is a
prerequisite. Specifically, for all these imaging modalities ACR accreditation is available, in addition AIUM is
available for Ultrasound, and ICANL for Nuclear Medicine. IAC accreditation is recognized for CT and MRI. For complete details or to download the Minimum Equipment Standards effective July 1, 2011, visit the Facility Assessment section of the CareCore National website at www.carecorenational.com/facility-assessment.asp.
UnitedHealthcare
UNITEDHEALTHCARE REQUIRES ACCREDITATION BY JANUARY 1, 2012 AS A CONDITION FOR REIMBURSEMENT
DECEMBER 2009 | UnitedHealth Group (UnitedHealthcare) released
the following announcement:
“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.
View
the full announcement, requirements for UnitedHealthcare»
Anthem Health Plans of Virginia, Inc. d/b/a
Anthem Blue Cross and Blue Shield and its HMO Affiliates
(VA)
APRIL 2008 | Anthem Health Plans of Virginia, Inc. d/b/a Anthem Blue Cross and Blue Shield and its HMO affiliates, announced that any 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.
View
the full announcement, requirements for Anthem Health Plans of Virginia»
Anthem Blue Cross and Blue Shield
(IN, KY, OH)
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
MARCH 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 to all practitioner group sites will enhance service quality and safety of the diagnostic imaging studies delivered to our members and your patients."
View
the full announcement, requirements for BCBSKC»
Highmark Blue Cross Blue Shield
(PA)
JULY 2004 | In a July 13, 2004 letter to providers, Highmark Blue Cross
Blue Shield announced that, effective January 1, 2005, all providers
of diagnostic imaging services performed outside of a hospital
setting will be required to adhere to new privileging guidelines. As detailed below, guidelines now exist related to each of the
accrediting bodies within the Intersocietal Accreditation Commission:
the ICANL, the ICAEL and the ICAVL.
View
the complete Highmark Privileging guidelines»
Horizon Blue Cross Blue Shield of New Jersey
(NJ)
In conjunction with CareCore National, LLC, Horizon BCBS of New Jersey includes implementation of diagnostic imaging.
Nuclear medicine studies require:
- Physicians certified by the American Board of Radiology (ABR) or the American Board of Nuclear Medicine (ABNM)
Nuclear cardiology studies require both:
- Physicians certified by the American Board of Radiology (ABR), the American Board of Nuclear Medicine (ABNM) or by the Certification Board for Nuclear Cardiology (CBNC)
- Laboratories accredited by Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) or the American College of Radiology (ACR)
Oxford Health Plans
It is important to note that Oxford Health Plans requires its
nuclear cardiology laboratories to be accredited by either the
ICANL or the ACR to receive reimbursement for nuclear cardiology
claims. Oxford Health Plans announced that all physicians must
meet one of the following standards effective February 2, 2004
in order to be reimbursed for nuclear cardiology procedures:
-
Certified by the Certification Board for Nuclear Cardiology (CBNC)
- Board certified in Nuclear Medicine by the American Board
of Nuclear Medicine (ABNM)
- Board certified in Radiology by the American Board of Radiology (ABR)
Get
more information by visiting the Oxford
Health Plans website»
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