Imaging Accreditation Program Frequently Asked Questions
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- Merry McKenzie
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1 Imaging Accreditation Program Frequently Asked Questions 1. What is the United Healthcare Imaging Accreditation Program? Imaging accreditation specifically addresses the quality and safety of medical imaging through the application of nationally recognized standards for providers of outpatient imaging services. 2. What is the deadline to obtain accreditation? Application for accreditation is encouraged to be submitted now to avoid delay for compliance by the third quarter of We will notify you a minimum of 30 days before the program becomes effective in your area, or as otherwise required by regulation. 3. Why was the deadline to obtain accreditation extended? After constructive and collegial feedback from physicians who participate in our network, we have decided to extend the accreditation program implementation date until the third quarter of Our goal is to have as many physicians and facilities accredited as quickly as possible; however, we understand that some facilities require more time to complete the process. 4. What are the imaging procedures subject to accreditation? The following imaging procedures are subject to accreditation: CT, CTA, MRI, MRA, Nuclear Medicine, Nuclear Cardiology, PET and Echocardiography. The most current and complete list of corresponding CPT codes is available on UnitedHealthcareOnline.com via Clinician Resources > Radiology > Imaging Accreditation. 5. Are other non-echocardiography ultrasound procedures subject to accreditation? Accreditation will initially apply to the above procedures with consideration for future application to other ultrasound services. 6. What facilities and/or physicians are required to obtain accreditation? Facilities and physicians that perform outpatient imaging studies and bill on a 1500 Health
2 Insurance Claim Form (HICF) or the electronic equivalent must obtain accreditation. Accreditation will apply to global and technical service claims. 7. How is the professional component affected by the accreditation requirements? The professional component is exempt from the imaging accreditation reimbursement requirement. 8. Who are the accreditation agencies United Healthcare will recognize to obtain accreditation for this program? American College of Radiology (ACR) Intersocietal Accreditation Commission (IAC) Is there a preferred agency? United Healthcare has no preference. Both the ACR and IAC accreditations are accepted. It is not necessary to obtain accreditation from both agencies for the same modality. 10. What is the first step to begin the imaging accreditation process? The first step toward obtaining accreditation is to review the accreditation guidelines and application processes located on the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) Web sites. OR Call the agencies using the phone numbers above to obtain a packet of information 11. How long will it take to become accredited? On average, it takes six to nine months to become accredited. However, there may be certain extenuating circumstances that may extend the accreditation process for some imaging sites. Important accreditation process details: The more organized an imaging site is, the easier it will be to complete the accreditation application. Follow the application instructions carefully and completely to expedite the accreditation process. Contact the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) for any questions related to the accreditation process.
3 12. What are the fees associated with becoming accredited with these agencies? Please refer to the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) for information about application fees. 13. Is it necessary to contact United Healthcare when accreditation is obtained? No. There is no need to contact United Healthcare upon applying for or receiving accreditation. An electronic exchange of accreditation information will be sent from the American College of Radiology and the Intersocietal Accreditation Commission to United Healthcare. 14. Will accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or the Accreditation Association for Ambulatory Healthcare (AAAHC) fulfill United Healthcare s imaging accreditation requirements? No. United Healthcare recognizes the ACR and IAC. These agencies have standards that address the imaging equipment, the images and quality assurance processes. The ACR and IAC focus their standards on an in-depth quality and safety clinical assessment regarding radiology equipment, personnel credentials, radiation safety and film interpretation. 15. Are there any exemptions to the accreditation requirements? The imaging accreditation requirements apply to commercial United Healthcare business. This program does not currently apply to members enrolled in benefit plans sponsored by Oxford Health Plans, PacifiCare, MAMSI, Options PPO, and Neighborhood Health Plan or to members enrolled in government programs such as AmeriChoice, Ovations, SecureHorizons, EverCare or Medicare Advantage. 16. Are UnitedHealth Premium designated physicians exempt from the accreditation requirements? No. UnitedHealth Premium designated physicians are not exempt from the imaging accreditation program. 17. What will result if an imaging site declines to apply for accreditation? When the program is implemented in Q3 2008, outpatient imaging facilities and physicians who have not applied for accreditation will not be eligible for reimbursement.
4 18. What will occur if the imaging site is in the process of obtaining accreditation when the deadline passes? Upon completion and submission of an accreditation application, you will be placed in a pending accreditation status for the modalities in the application for 12 months from the date of submission, or until you have received a decision on your accreditation application, whichever occurs first. During this pending status, your claims will not be denied under this protocol. 19. What will occur if a physician or facility receives a letter from the ACR or IAC stating they have failed to meet the accreditation requirements? Accreditation applicants are encouraged to contact the American College of Radiology (ACR) or Intersocietal Accreditation Commission (IAC) for details on resubmission. 20. If a physician or facility fails to obtain accreditation, how will the reimbursement be affected? The physician or facility will not be reimbursed if accreditation is not obtained and a claim denial will occur for the service. 21. What is the claim denial code? How will the description appear on the EOB? The denial code is GH. The description is The procedure code submitted must be performed at an accredited facility under the United Healthcare imaging accreditation protocol. The member cannot be billed for the declined amount. 22. Can the provider balance bill the member? No. The member is held harmless. 23. If the provider or imaging site is accredited, do they still need to meet the notification requirements? Yes. The provider must still comply with the notification requirements. 24. What are the requirements for mobile imaging equipment? American College of Radiology (ACR) requirements If a unit serves multiple sites and the imaging protocols and interpreting physician group are the same at each site, then one application and fee should be submitted. If a unit serves multiple locations and the protocols and interpreting physician groups vary
5 from site to site, then each site is required to submit separate applications and fees. Intersocietal Accreditation Commission (IAC) requirements All procedures that are performed at the mobile locations must be interpreted by the physicians included in the application for accreditation. All technologists performing any procedures at the mobile locations must be included in the application for accreditation. The entire mobile service must share the same medical director and technical director All physicians and technologists must participate together in quality assurance and education programs, including in-house conferences. The en&re mobile service must u&lize similar protocols.
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