Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 380 Date: August 3, 2011

Transcription

1 anual ystem Pub edicare Program ntegrity Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 380 Date: ugust 3, 2011 hange equest 7177 NOTE: Transmittal 373, dated pril 7, 2011, is rescinded and replaced by Transmittal 380, dated ugust 3, 2011, to update the changes to the -855 and -855B which will be within section 2 and will be for newly enrolling providers and suppliers now that specialty code 95 will not be used for dvanced Diagnostic maging (D). D suppliers that are currently enrolled and accredited by the recognized accrediting bodies will take no additional action. ll other information remains the same. UBJET: dvanced Diagnostic maging ccreditation Enrollment Procedures. UY O NGE: The approved several accreditation organizations (Os) to provide accreditation services for suppliers of the technical component (T) of advanced diagnostic imaging procedures. The accreditation will apply only to the suppliers of the images themselves, and not to the physician s interpretation of the image. This accreditation only applies to those who are paid under the Physician ee chedule. ll accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. Therefore, this change request () will set the systems parameters for this accreditation requirement. provider submitting claims for the T must be accredited by January 1, 2012 to be reimbursed for the claim if the service is performed on or after that date. EETVE DTE: July 1, 2011 PLEENTTON DTE: July 5, 2011 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED-Only One Per ow. /N/D PTE / ETON / UBETON / TTLE 15/15.5/dvanced Diagnostic maging. UNDNG: or iscal ntermediaries (s), egional ome ealth ntermediaries (s) and/or arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically

2 authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTENT: Business equirements anual nstruction *Unless otherwise specified, the effective date is the date of service.

3 ttachment - Business equirements Pub Transmittal: 380 Date: ugust 3, 2011 hange equest: 7177 NOTE: Transmittal 373, dated pril 7, 2011, is rescinded and replaced by Transmittal 380, dated ugust 3, 2011, to update the changes to the -855 and -855B which will be within section 2 and will be for newly enrolling providers and suppliers now that specialty code 95 will not be used for dvanced Diagnostic maging (D). D suppliers that are currently enrolled and accredited by the recognized accrediting bodies will take no additional action. ll other information remains the same. UBJET: dvanced Diagnostic maging ccreditation Enrollment Procedures EETVE DTE: July 1, 2011 PLEENTTON DTE: July 5, GENEL NOTON. Background: The enters for edicare & edicaid ervices () approved three national accreditation organizations (Os) the merican ollege of adiology, the ntersocietal ccreditation ommission, and The Joint ommission - to provide accreditation services for suppliers of the technical component (T) of advanced diagnostic imaging procedures. The accreditation will apply only to the suppliers of the images themselves, and not to the physician's interpretation of the image. This accreditation only applies to those who are paid under the Physician ee chedule. ll accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. Therefore, this change request () will set the systems parameters for this accreditation requirement. provider submitting claims for the T must be accredited by January 1, 2012, to be reimbursed for the claim if the service is performed on or after that date. Each of these designated Os submits monthly reports to that list the suppliers of who have been or are accredited, as well as the beginning and end date of the accreditation and the respective modalities for which they receive accreditation. The physicians and non-physician practitioners described above must do the following: Newly enrolling physicians and nonphysician practitioners must complete nternet-based PEO or the appropriate -855 and the section for dvanced Diagnostic maging (D), and mail the completed form to the designated edicare enrollment contractor. Those physicians and nonphysician practitioners currently enrolled in the edicare program and who are accredited by an accreditation organization recognized by for this program do not need to take action as their accreditation information will be transmitted to by these organizations where it will then be loaded into the Provider Enrollment, hain and Ownership ystem (PEO). ontractors shall accept applications from providers and suppliers who are accredited for the D accreditation. The edicare enrollment contractors shall verify the information sent on the application meets the current enrollment requirements. The edicare enrollment contractors shall verify the D supplier is listed as one of the accredited individuals/organizations found at and consistent with accreditation information found in section 2 of the -855, and if the application is approved, will enter the information into PEO.

4 ontractors shall hold all application, paper or internet-based, if received prior to the implementation date of the. B. Policy: ection 135(a) of the edicare mprovements for Patients and Providers ct of 2008 (PP) amended section 1834(e) of the ocial ecurity ct and required the ecretary to designate organizations to accredit suppliers, including but not limited to physicians, non-physician practitioners and ndependent Diagnostic Testing acilities, that furnish the T of advanced diagnostic imaging services. The PP specifically defines advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging (), computed tomography (T), and nuclear medicine imaging such as positron emission tomography (PET). The law also authorizes the ecretary to specify other diagnostic imaging services in consultation with physician specialty organizations and other stakeholders. n order to furnish the T of advanced diagnostic imaging services for edicare beneficiaries, suppliers must be accredited by January 1, The effective date of previously named regulation is January 1, BUNE EQUEENT TBLE Number equirement esponsibility / D B E ontractors shall verify the information sent on the application and the list on the website, and once the application is approved, shall enter the information into the PEO ontractors shall use the date of filing as the effective date for D accreditation in PEO and ontractors shall populate all PEO effective dates with the date of accreditation listed on receipt of the ontractors shall hold all application, paper or internetbased, if received prior to the implementation date of the. E hared- ystem aintainers ailroad is exempt from the requirements of this V W Other

5 . POVDE EDUTON TBLE Number equirement esponsibility ( / D B E provider education article related to this instruction will be available at shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. E hared- ystem aintainers V W Other ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. V. UPPOTNG NOTON ection : ecommendations and supporting information associated with listed requirements: N/ -ef equirement Number ecommendations or other supporting information: ection B: ll other recommendations and supporting information: N/ V. ONTT Pre-mplementation ontact(s): ugust Nemec ugust.nemec@cms.hhs.gov or andra Bastinelli andra.bastinelli@cms.hhs.gov Post-mplementation ontact(s): ontact your ontracting Officer s Technical epresentative (OT) or ontractor anager, as applicable.

6 V. UNDNG ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s), and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

7 15.5- dvanced Diagnostic maging (ev. 380, ssued: , Effective: , mplementation: ) ection 135(a) of the edicare mprovements for Patients and Providers ct of 2008 (PP) amended section 1834(e) of the ocial ecurity ct and required the ecretary to designate organizations to accredit suppliers, including but not limited to physicians, non-physician practitioners and ndependent Diagnostic Testing acilities, that furnish the T of advanced diagnostic imaging services. PP specifically defines advanced diagnostic imaging procedures as including diagnostic magnetic resonance imaging (), computed tomography (T), and nuclear medicine imaging such as positron emission tomography (PET). The law also authorizes the ecretary to specify other diagnostic imaging services in consultation with physician specialty organizations and other stakeholders. n order to furnish the T of advanced diagnostic imaging services for edicare beneficiaries, suppliers must be accredited by January 1, The effective date of previously named regulation is January 1, The enters for edicare & edicaid ervices () approved three national accreditation organizations (Os) the merican ollege of adiology, the ntersocietal ccreditation ommission, and The Joint ommission - to provide accreditation services for suppliers of the technical component (T) of advanced diagnostic imaging procedures. The accreditation will apply only to the suppliers of the images themselves, and not to the physician's interpretation of the image. This accreditation only applies to those who are paid under the Physician ee chedule. ll accreditation organizations have quality standards that address the safety of the equipment as well as the safety of the patients and staff. provider submitting claims for the T must be accredited by January 1, 2012 to be reimbursed for the claim if the service is performed on or after that date. Each of these designated Os submits monthly reports to that list the suppliers of who have been or are accredited, as well as the beginning and end date of the accreditation and the respective modalities for which they receive accreditation. Newly enrolling physicians and non-physician practitioners described above must complete nternet-based PEO or the appropriate -855 and check the appropriate boxes for dvanced Diagnostic maging (D). ontractors shall accept applications from providers and suppliers who are accredited for the new D accreditation. The edicare enrollment contractors shall verify the information sent on the application meets the current enrollment requirements. The edicare enrollment contractors shall verify the D supplier is listed as one of the accredited individuals/organizations found at and consistent with accreditation information found in section 2 of the -855, and if the application is approved, will enter the information into the Provider Enrollment, hain and Ownership ystem (PEO).