By Adrienne Dresevic, Esq. and Carey F. Kalmowitz, Esq.
March 2010 — The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires the Secretary of the Department of Health and Human Services (the Secretary) to designate organizations to accredit suppliers, including but not limited to physicians, non physician practitioners, and independent diagnostic testing facilities, that furnish the technical component (TC) of advanced diagnostic imaging services. The MIPPA accreditation requirement applies only to suppliers of the TC of advanced imaging services (ie, MRI, CT, PET, and nuclear medicine) which are supplied on an outpatient basis and billed to Medicare under the physician fee schedule. It does not apply to advanced imaging services provided by inpatient or outpatient centers billing under the hospital. This accreditation requirement also does not apply to the physician’s interpretation of the images. Although the law allows the Secretary to supplement the list of diagnostic imaging services that will require accreditation, MIPPA currently defines advanced diagnostic imaging services as diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine imaging (the definition specifically excludes x-rays, ultrasounds, fluorscopy procedures, and diagnostic and screening mammography). Thus, if a supplier furnishes the TC of advanced diagnostic imaging services, as defined above, to Medicare beneficiaries, the supplier must be accredited by January 1, 2012 in order to receive payment under the physician fee schedule.
As required by MIPPA, on January 26, 2010, the Centers for Medicare & Medicaid Services (CMS) published notice that it approved the following three national accreditation organizations to provide the accreditation services for suppliers of the TC of advanced diagnostic imaging procedures: 1) the American College of Radiology (ACR); 2) the Intersocietal Accreditation Commission (IAC); and 3) The Joint Commission (JC). When selecting the accrediting organizations to approve, CMS focused on the organizations’ ability to conduct timely reviews of applications, the integration of new imaging services into the accreditation program, the use of onsite visits, the ability to address the capacity of imaging suppliers in rural areas, and whether or not their fees were reasonable.
Quality Standards for Accreditation
The accreditation organizations are authorized to prescribe quality standards for practices and assist practices to continuously improve the quality of care that they provide to their patients by providing an objective, peer reviewed assessment of facilities. In order to serve this purpose, the organizations assess the following:
- Qualifications of non physician personnel performing the imaging;
- Qualifications and responsibilities of medical directors and supervising physicians;
- Procedures to ensure safety of the individuals furnishing the imaging and the patients;
- Procedures to ensure the reliability, clarity, and technical quality of the diagnostic images;
- Procedures to assist the patient in obtaining his/her imaging records; and
- Procedures to notify CMS of any changes to imaging modalities subsequent to the accreditation organization’s decision.
At this point, the degree to which MIPPA’s requirements will subject providers to additional burdens remains to be seen. From informal discussions with CMS and other industry “insiders,” the prevailing expectation is that MIPPA will materially elevate the standards to which providers must adhere with a corresponding increase in the cost of providing advanced imaging services.
CMS is expected to issue further guidance in connection with meeting the MIPPA accreditation standards. Suppliers that furnish the TC of advanced diagnostic imaging services must seek accreditation from the ACR, IAC, or JC by January 1, 2012. CMS plans to provide education outreach to all suppliers that are affected by these new requirements so that suppliers understand the MIPPA requirements and will be able to comply with them prior to the January 1, 2012 deadline. These organizations have different accreditation standards and application processes for each of the advanced diagnostic imaging services. Suppliers are well advised to begin obtaining information from the accreditation organizations. To obtain information from the selected accreditation organizations, suppliers can contact them as follows:
505 9th St. N.W.
Washington, DC 20004
6021 University Boulevard, Suite 500
Ellicott City, MD 21043
- The Joint Commission
601 13th Street, NW
Suite 1150 N
Washington, DC 20005
Adrienne Dresevic, Esq. is a founding member of The Health Law Partners, P.C. She is a member of the American Bar Association, State Bar of New York, State Bar of Michigan, Health Law Section, American Health Lawyers Association, and serves as an editorial board member for the ABA’s e-Source and the ABA’s Publications Committee. Ms.Dresevic can be reached at email@example.com.
Carey F. Kalmowitz, Esq. is a founding member of The Health Law Partners, P.C. He is a member of the State Bar of New York, State Bar of Michigan, the Michigan Society of Hospital Attorneys, the American Health Lawyer’s Association, and the American Bar Association. Mr. Kalmowitz can be reached at firstname.lastname@example.org.