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Payer mandates imagingaccreditation by March 2008

Radiology Administrator's Compliance and Reimbursement Insider, June 1, 2007

Freestanding facilities, physician offices scramble to start application process

The days of voluntary accreditation are over for many in imaging. If you work in a freestanding imaging facility or physician's office and expect UnitedHealthcare (UHc) payments after March 2008, accreditation is no longer a choice-it's mandatory.

Facilities that already maintain American College of Radiology (ACR) or Intersocietal Accreditation Com-mission (IAC) status do not need to worry about the new requirements. Although UHc initially notified providers in January giving them 14 months of total preparation time, more than 10,000 facilities nationwide now have less than nine months to achieve accreditation.

Practice requires more than overnight service

"If you want to be accredited by next March, you'd better start preparing by June at the latest," says W. Geoffrey West, M.Eng., DABR, CHP, president of the Atlanta-based West Physics Consulting. "The problem is that many people haven't even heard about this yet."

Because the process takes anywhere from six to nine months to complete, that leaves little wiggle room for hesitation.

"Our best recommendation is to start sooner, rather than later," says Sandra Katanick, CEO of IAC, based in Columbia, MD.

Although some facilities may garner an extension due to extenuating circumstances, don't count on it.

"The primary concern is allowing adequate time to complete the accreditation process," says Laurie Paidosh, UHc's director of radiology programs.

Imaging growth drives payer regulations

Many see increased quality requirements as essential to reducing unnecessary exams and, thereby, reducing escalating costs. UHc represents one of the nation's largest payers. With the organization throwing its support behind accreditation, industry experts expect to see other insurers following UHc's lead.

"Many other third-party payers previously required accreditation as a condition for reimbursement for certain imaging modalities," Paidosh says. "We recognize that we are the first to require [this] on a broad-based, multi-modality level, but strongly believe it will advance safety and quality for all consumers of these services."

The UHc announcement comes amid a climate of exponential growth in the medical imaging world.

Further, nonhospital imaging settings maintain no consistent standards of operation, according to a February ACR Bulletin article. That means no across-the-board standards of suitable staff education or training, proper maintenance of equipment, or appropriate certification for technologists.

Although certain state legislatures do maintain particular equipment and experience requirements, the regulations are disparate across the country. UHc's requirements stretch across its coverage states.

"Significant variations exist in the quality, safety, and appropriate utilization of imaging services in healthcare delivery," says Paidosh. These variations "affect the quality, safety, and affordability of healthcare. Accreditation programs have emerged as key initiatives to advance the quality and safety of imaging studies," she says.

Policy requirements focus on shared standards

The policy requires UHc-affiliated practices to obtain accreditation from either the ACR or the IAC for most diagnostic radiology procedures-CT, CT angiography, MRI, nuclear medicine, PET, and echocardiography.

These represent areas, given the specialized physician experience and advanced technology required in these procedures, in which performance standards continue to gain in importance, says Paidosh.

"Accreditation assesses the overall quality of a practice, including personnel, equipment, quality assurance activities, and ultimately, the quality of patient care," said Arl Van Moore Jr., MD, FACR, chair of the ACR Board of Chancellors, in a January UHc release.

Associations offer similar basic requirements

Both accreditation associations maintain their own particular processes, but stay true to certain tenants of quality.

Some shared accreditation assessments include: