CMS Payment Policies (By State)

Transcription

1 CMS Payment Policies (By State) To date, IAC is aware of the following states that have adopted CMS reimbursement directives. There are several states in which the Medicare carrier requires or recommends either accreditation of the facility and/or staff credentialing, for reimbursement of echocardiography studies. While IAC attempts to stay abreast of reimbursement policies mandated by CMS as a service to the echocardiography community, these policies are changed and updated regularly by the insurance carriers. Therefore, IAC recommends that applicant facilities contact the insurance carriers in their area for the most accurate and current information to ensure compliance with reimbursement requirements at all times. If you are aware of additional payment policies, or have questions about the information posted, please reimbursement@intersocietal.org. PLEASE NOTE: The policy details within this document detailing accreditation requirements are only a portion of the full reimbursement directive, please search for the full policy on the CMS or your jurisdiction s appropriate AB MAC website. Don t know your jurisdiction or contractor? Search on the CMS website here. IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 1 PLEASE NOTE: These policies are changed and updated regularly by the insurance carriers and list requirements as related to IAC accreditation only. Therefore, the IAC recommends that applicant facilities contact the insurance carriers in their area for the most accurate and current information to ensure compliance with reimbursement requirements at all times. Further

2 Medicare Payment Policies Medicare communicates echocardiography payment policy primarily through contractor-specific Local Coverage Determinations (LCDs). Select your state below to view the LCDs for your state: Alabama Alaska American Samoa Islands Arizona Arkansas California Northern & Southern Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota North Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming PLEASE NOTE: The policy details displayed on the IAC website detailing accreditation requirements are only a portion of the full reimbursement directive, please review the full policy on the CMS website to ensure you are in compliance with the complete policy. To find a payment policy, go to and follow these instructions: 1. Click on Advanced Search 2. Under Search by Document Type, check Local Coverage Documents 3. Under What documents types do you want to search for? Check All Policies (LCD) and then Final Policies 4. Select Geographic Area (State) AND/OR Contractor Criteria 5. Type the testing area you are searching for (i.e., echocardiography) or the LCD ID # into Enter Keyword(s) box and choose Entire Document 6. Click Search By Type box 7. A page will appear asking you to accept the Terms & Conditions, Click Agree 8. A new page will open with your search results IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 2 PLEASE NOTE: These policies are changed and updated regularly by the insurance carriers and list requirements as related to IAC accreditation only. Therefore, the IAC recommends that applicant facilities contact the insurance carriers in their area for the most accurate and current information to ensure compliance with reimbursement requirements at all times. Further

3 Alabama Contractor Name: Cahaba Government Benefit Administrators The state of Alabama falls under Jurisdiction 10 for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Alabama under Cahaba that require or recommend IAC accreditation as a condition for reimbursement for echocardiography studies. Cahaba Government Benefit Administrators, LLC (Cahaba GBA) is the J10 Medicare Administrative Contractor (MAC) for the state of Alabama. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 3

4 Alaska Contractor Name: Noridian Healthcare Solutions The state of Alaska falls under Jurisdiction F for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Alaska under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JF Medicare Administrative Contractor (MAC) for the state of Alaska. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 4

5 American Samoa Islands Contractor Name: Noridian Healthcare Solutions The American Samoa Islands fall under Jurisdiction E for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the American Samoa Islands under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JE Medicare Administrative Contractor (MAC) for the American Samoa Islands. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 5

6 Arizona Contractor Name: Noridian Healthcare Solutions The state of Arizona falls under Jurisdiction F for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Arizona under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JF Medicare Administrative Contractor (MAC) for the state of Arizona. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 6

7 Arkansas Contractor Name: Novitas Solutions The state of Arkansas falls under Jurisdiction H for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Arkansas under Novitas that require IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JH Medicare Administrative Contractor (MAC) for the state of Arkansas. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 7

8 California Northern & Southern Contractor Name: Noridian Healthcare Solutions The state of California fall under Jurisdiction E for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of California under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JE Medicare Administrative Contractor (MAC) for the state of California. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 8

9 Colorado Contractor Name: Novitas Solutions The state of Colorado falls under Jurisdiction H for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Colorado under Novitas that require IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JH Medicare Administrative Contractor (MAC) for the state of Colorado. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 9

10 Connecticut Contractor Name: National Government Services, Inc. LCD ID #: L33577 Effective: For services performed before or after 10/1/2015 Revision Effective: For services performed before or after 10/1/2015 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements While it is not the Contractor's intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: 1. The service is performed by a physician; or 2. The technical service is performed by an individual who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or 3. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission (IAC) in Echocardiography (formerly ICAEL). Any non-physician personnel used by an IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropriate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropriate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met. For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: 1. The physician is board certified in Cardiovascular Diseases; or 2. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document. For Facilities, quality requirements should encompass approved ACC/AHA/ASE training standards for physicians, accreditation by IAC Echocardiography (formerly ICAEL) for facilities and certification of cardiac sonographers by recognized national credentialing organizations as the appropriate quality standards. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. NGS providers, including those in the state of New York (note change in credentialing criteria), but with the exception of Illinois (Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (Part B providers), submitting claims for these services will be allowed a 2-year grace period (until 07/01/2011) to meet these standards. The requirements will be effective in Illinois (for Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (for Part B providers) on January 1, IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 10

11 Delaware Contractor Name: Novitas Solutions The state of Delaware falls under Jurisdiction L for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Delaware under Novitas that require IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JL Medicare Administrative Contractor (MAC) for the state of Delaware. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 11

12 District of Columbia Contractor Name: Novitas Solutions The District of Columbia falls under Jurisdiction L for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the District of Columbia under Novitas that require IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JL Medicare Administrative Contractor (MAC) for the District of Columbia. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 12

13 Florida Contractor Name: First Coast Service Options, Inc. Contractor Type: A & B MAC LCD ID #: L33768 Original Effective Date: For services performed on or after 10/1/2015 Revision Effective Date: For services performed on or after 10/1/2015 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements: While it is not the Carrier s intention or jurisdiction to credential providers, a satisfactory level of competence is expected from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: a. The service is performed by a physician; or b. The service is performed by a technician who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or c. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission Echocardiography (formerly ICAEL). For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: a. The physician is board certified in Cardiovascular Diseases; or b. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document; or c. The physician provides the interpretation in conjunction with a study that is performed at a laboratory that is accredited by the Intersocietal Accreditation Commission Echocardiography (formerly ICAEL) and that is subject to such laboratory s quality assurance policies and procedures; or d. The physician has staff privileges to interpret echocardiograms at a hospital that participates in the Medicare program. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. However, a grace period of two years will be allowed for providers to acquire the necessary training. All echocardiography services require a referring or an ordering physician. However, if the facility has a documented process for grand-fathering experienced technicians who have performed the services referenced in this LCD (a process addressing years of service and experience with number of supervised cases), this documentation should be available upon request; otherwise the provider must have documentation available upon request which indicates that the technician meets the credentialing requirements as stated above or is in the process of obtaining this credentialing. IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 13

14 Georgia Contractor Name: Cahaba Government Benefit Administrators The state of Georgia falls under Jurisdiction 10 for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Georgia under Cahaba that require or recommend IAC accreditation as a condition for reimbursement for echocardiography studies. Cahaba Government Benefit Administrators, LLC (Cahaba GBA) is the J10 Medicare Administrative Contractor (MAC) for the state of Georgia. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 14

15 Guam Contractor Name: Noridian Healthcare Solutions Guam falls under Jurisdiction E for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in Guam under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JE Medicare Administrative Contractor (MAC) for Guam. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 15

16 Hawaii Contractor Name: Noridian Healthcare Solutions The state of Hawaii fall under Jurisdiction E for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Hawaii under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JE Medicare Administrative Contractor (MAC) for the state of Hawaii. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 16

17 Idaho Contractor Name: Noridian Healthcare Solutions The state of Idaho falls under Jurisdiction F for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Idaho under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JF Medicare Administrative Contractor (MAC) for the state of Idaho. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 17

18 Illinois Contractor Name: National Government Services, Inc. LCD ID #: L33577 Effective: For services performed before or after 10/1/2015 Revision Effective: For services performed before or after 10/1/2015 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements While it is not the Contractor's intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: 1. The service is performed by a physician; or 2. The technical service is performed by an individual who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or 3. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission (IAC) in Echocardiography (formerly ICAEL). Any non-physician personnel used by an IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropriate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropriate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met. For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: 1. The physician is board certified in Cardiovascular Diseases; or 2. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document. For Facilities, quality requirements should encompass approved ACC/AHA/ASE training standards for physicians, accreditation by IAC Echocardiography (formerly ICAEL) for facilities and certification of cardiac sonographers by recognized national credentialing organizations as the appropriate quality standards. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. NGS providers, including those in the state of New York (note change in credentialing criteria), but with the exception of Illinois (Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (Part B providers), submitting claims for these services will be allowed a 2-year grace period (until 07/01/2011) to meet these standards. The requirements will be effective in Illinois (for Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (for Part B providers) on January 1, IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 18

19 Indiana Contractor Name: Wisconsin Physicians Service Insurance Corporation The state of Indiana falls under Jurisdiction 8 for Part A and Part B Medicare claims. Presently, there are no known CMS policies in the state of Indiana that require or recommend IAC accreditation as a condition for reimbursement for Echocardiography studies. WPS Medicare is the J8 Medicare Administrative Contractor (MAC) for the state of Indiana. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 19

20 Iowa Contractor Name: Wisconsin Physicians Service Insurance Corporation The state of Iowa falls under Jurisdiction 5 for Part A and Part B Medicare claims. Presently, there are no known CMS policies in the state of Iowa that require or recommend IAC accreditation as a condition for reimbursement for Echocardiography studies. WPS Medicare is the J5 Medicare Administrative Contractor (MAC) for the state of Iowa. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 20

21 Kansas Contractor Name: Wisconsin Physicians Service Insurance Corporation The state of Kansas falls under Jurisdiction 5 for Part A and Part B Medicare claims. Presently, there are no known CMS policies in the state of Kansas that require or recommend IAC accreditation as a condition for reimbursement for Echocardiography studies. WPS Medicare is the J5 Medicare Administrative Contractor (MAC) for the state of Kansas. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 21

22 Kentucky Contractor Name: CGS Administrators, LLC. LCD ID #: L34338 Original Effective Date: For services performed on or after 10/1/2015 Revision Effective Date: For services performed on or after 1/1/2016 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements While it is not the Contractor s intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: 1. The service is performed by a physician; or 2. The technical service is performed by an individual who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or 3. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission (IAC) in Echocardiography (formerly ICAEL). Any non-physician personnel used by an IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropriate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropriate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met. For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: 1. The physician is board certified in Cardiovascular Diseases; or 2. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document. For Facilities, quality requirements should encompass approved ACC/AHA/ASE training standards for physicians, accreditation by IAC Echocardiography (formerly ICAEL) for facilities and certification of cardiac sonographers by recognized national credentialing organizations as the appropriate quality standards. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. CGS providers submitting claims for these services will be allowed a 2-year grace period (until 07/01/2011) to meet these standards. IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 22

23 Louisiana Contractor Name: Novitas Solutions The state of Louisiana falls under Jurisdiction H for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Louisiana under Novitas that require or recommend IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JH Medicare Administrative Contractor (MAC) for the state of Louisiana. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 23

24 Maine Contractor Name: National Government Services, Inc. LCD ID #: L33577 Effective: For services performed before or after 10/1/2015 Revision Effective: For services performed before or after 10/1/2015 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements While it is not the Contractor s intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: 1. The service is performed by a physician; or 2. The technical service is performed by an individual who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or 3. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission (IAC) in Echocardiography (formerly ICAEL). Any non-physician personnel used by an IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropriate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropriate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met. For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: 1. The physician is board certified in Cardiovascular Diseases; or 2. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document. For Facilities, quality requirements should encompass approved ACC/AHA/ASE training standards for physicians, accreditation by IAC Echocardiography (formerly ICAEL) for facilities and certification of cardiac sonographers by recognized national credentialing organizations as the appropriate quality standards. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. NGS providers, including those in the state of New York (note change in credentialing criteria), but with the exception of Illinois (Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (Part B providers), submitting claims for these services will be allowed a 2-year grace period (until 07/01/2011) to meet these standards. The requirements will be effective in Illinois (for Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (for Part B providers) on January 1, IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 24

25 Maryland Contractor Name: Novitas Solutions The state of Maryland falls under Jurisdiction L for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Maryland under Novitas that require IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JL Medicare Administrative Contractor (MAC) for the state of Maryland. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 25

26 Massachusetts Contractor Name: National Government Services, Inc. LCD ID #: L33577 Effective: For services performed before or after 10/1/2015 Revision Effective: For services performed before or after 10/1/2015 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements While it is not the Contractor s intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: 1. The service is performed by a physician; or 2. The technical service is performed by an individual who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or 3. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission (IAC) in Echocardiography (formerly ICAEL). Any non-physician personnel used by an IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropriate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropriate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met. For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: 1. The physician is board certified in Cardiovascular Diseases; or 2. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document. For Facilities, quality requirements should encompass approved ACC/AHA/ASE training standards for physicians, accreditation by IAC Echocardiography (formerly ICAEL) for facilities and certification of cardiac sonographers by recognized national credentialing organizations as the appropriate quality standards. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. NGS providers, including those in the state of New York (note change in credentialing criteria), but with the exception of Illinois (Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (Part B providers), submitting claims for these services will be allowed a 2-year grace period (until 07/01/2011) to meet these standards. The requirements will be effective in Illinois (for Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (for Part B providers) on January 1, IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 26

27 Michigan Contractor Name: Wisconsin Physicians Service Insurance Corporation The state of Michigan falls under Jurisdiction 8 for Part A and Part B Medicare claims. Presently, there are no known CMS policies in the state of Michigan that require or recommend IAC accreditation as a condition for reimbursement for Echocardiography studies. WPS Medicare is the J8 Medicare Administrative Contractor (MAC) for the state of Michigan. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 27

28 IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 28

29 Minnesota Contractor Name: National Government Services, Inc. LCD ID #: L33577 Effective: For services performed before or after 10/1/2015 Revision Effective: For services performed before or after 10/1/2015 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements While it is not the Contractor s intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: 4. The service is performed by a physician; or 5. The technical service is performed by an individual who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or 6. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission (IAC) in Echocardiography (formerly ICAEL). Any non-physician personnel used by an IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropriate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropriate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met. For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: 3. The physician is board certified in Cardiovascular Diseases; or 4. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document. For Facilities, quality requirements should encompass approved ACC/AHA/ASE training standards for physicians, accreditation by IAC Echocardiography (formerly ICAEL) for facilities and certification of cardiac sonographers by recognized national credentialing organizations as the appropriate quality standards. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. NGS providers, including those in the state of New York (note change in credentialing criteria), but with the exception of Illinois (Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (Part B providers), submitting claims for these services will be allowed a 2-year grace period (until 07/01/2011) to meet these standards. The requirements will be effective in Illinois (for Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (for Part B providers) on January 1, IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 29

30 Mississippi Contractor Name: Novitas Solutions The state of Mississippi falls under Jurisdiction H for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Mississippi under Novitas that require or recommend IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JH Medicare Administrative Contractor (MAC) for the state of Mississippi. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 30

31 Missouri Contractor Name: Wisconsin Physicians Service Insurance Corporation The state of Missouri falls under Jurisdiction 5 for Part A and Part B Medicare claims. Presently, there are no known CMS policies in the state of Missouri that require or recommend IAC accreditation as a condition for reimbursement for echocardiography studies. WPS Medicare is the J5 Medicare Administrative Contractor (MAC) for the state of Missouri. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 31

32 Montana Contractor Name: Noridian Healthcare Solutions The state of Montana falls under Jurisdiction F for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Montana under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JF Medicare Administrative Contractor (MAC) for the state of Montana. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 32

33 Nebraska Contractor Name: Wisconsin Physicians Service Insurance Corporation The state of Nebraska falls under Jurisdiction 5 for Part A and Part B Medicare claims. Presently, there are no known CMS policies in the state of Nebraska that require IAC accreditation as a condition for reimbursement for echocardiography studies. WPS Medicare is the J5 Medicare Administrative Contractor (MAC) for the state of Nebraska. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 33

34 Nevada Contractor Name: Noridian Healthcare Solutions The state of Nevada fall under Jurisdiction E for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of Nevada under Noridian that require IAC accreditation as a condition for reimbursement for echocardiography studies. Noridian Healthcare Solutions is the JE Medicare Administrative Contractor (MAC) for the state of Nevada. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 34

35 New Hampshire Contractor Name: National Government Services, Inc. LCD ID #: L33577 Effective: For services performed before or after 10/1/2015 Revision Effective: For services performed before or after 10/1/2015 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements While it is not the Contractor s intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: 1. The service is performed by a physician; or 2. The technical service is performed by an individual who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or 3. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission (IAC) in Echocardiography (formerly ICAEL). Any non-physician personnel used by an IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropriate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropriate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met. For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: 1. The physician is board certified in Cardiovascular Diseases; or 2. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document. For Facilities, quality requirements should encompass approved ACC/AHA/ASE training standards for physicians, accreditation by IAC Echocardiography (formerly ICAEL) for facilities and certification of cardiac sonographers by recognized national credentialing organizations as the appropriate quality standards. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. NGS providers, including those in the state of New York (note change in credentialing criteria), but with the exception of Illinois (Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (Part B providers), submitting claims for these services will be allowed a 2-year grace period (until 07/01/2011) to meet these standards. The requirements will be effective in Illinois (for Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (for Part B providers) on January 1, IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 35

36 New Jersey Contractor Name: Novitas Solutions The state of New Jersey falls under Jurisdiction L for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of New Jersey under Novitas that require IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JL Medicare Administrative Contractor (MAC) for the state of New Jersey. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 36

37 New Mexico Contractor Name: Novitas Solutions The state of New Mexico falls under Jurisdiction H for Part A and Part B Medicare claims. Presently, there are no known Part A & B CMS policies in the state of New Mexico under Novitas that require IAC accreditation as a condition for reimbursement for echocardiography studies. Novitas Solutions is the JH Medicare Administrative Contractor (MAC) for the state of New Mexico. To review all active LCDs, please visit IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 37

38 New York Contractor Name: National Government Services, Inc. LCD ID #: L33577 Effective: For services performed before or after 10/1/2015 Revision Effective: For services performed before or after 10/1/2015 LCD Title: Transthoracic Echocardiography (TTE) Training Requirements While it is not the Contractor s intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services. The acceptable levels of competence are outlined as follows: For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions: 1. The service is performed by a physician; or 2. The technical service is performed by an individual who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or 3. The service is performed at a laboratory (e.g. office, IDTF), credentialed by the Intersocietal Accreditation Commission (IAC) in Echocardiography (formerly ICAEL). Any non-physician personnel used by an IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as evidenced by licensure or certification by the appropriate State health or education department. In the absence of a State licensing board, the technician must be certified by an appropriate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met. For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements: 1. The physician is board certified in Cardiovascular Diseases; or 2. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/ American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document. For Facilities, quality requirements should encompass approved ACC/AHA/ASE training standards for physicians, accreditation by IAC Echocardiography (formerly ICAEL) for facilities and certification of cardiac sonographers by recognized national credentialing organizations as the appropriate quality standards. The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. NGS providers, including those in the state of New York (note change in credentialing criteria), but with the exception of Illinois (Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (Part B providers), submitting claims for these services will be allowed a 2-year grace period (until 07/01/2011) to meet these standards. The requirements will be effective in Illinois (for Part B providers), Maine, Massachusetts, Minnesota, New Hampshire, Rhode Island, Vermont and Wisconsin (for Part B providers) on January 1, IAC Echocardiography (formerly ICAEL) CMS Payment Policies (Last Reviewed by the IAC on 4/5/2016) 38