By Adrienne Dresevic, Esq. and Carey F. Kalmowitz, Esq.
September 2011–The Centers for Medicare & Medicaid Services (CMS) issued Transmittal 380 on August 3, 2011 in order to update CMS enrollment application forms (ie, CMS 855 I and CMS 855 B) to reflect information regarding Advanced Diagnostic Imaging (ADI) accreditation. Transmittal 380 does not require ADI suppliers that are currently enrolled and accredited by a CMS recognized body to take any action.
By way of background, pursuant to the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), CMS designated three national accreditation organizations (AOs) to accredit suppliers (including physicians, non-physician practitioners and independent diagnostic testing facilities) who furnish the technical component (TC) of advanced diagnostic imaging (ADI) procedures. As defined by MIPPA, the covered ADI services are limited to MRI, CT, and nuclear medicine, such as PET. However, other diagnostic imaging services may be added to the list in the future at the discretion of the Secretary in consultation with certain stakeholders. Notably, the accreditation requirement applies only to the suppliers of the ADI services, and not to the physician’s interpretation of an image. In addition, this accreditation only applies to those who are paid under the Physician Fee Schedule. The CMS approved AOs responsible for supplier accreditation are the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC), and The Joint Commission. These AOs are authorized to prescribe quality standards applicable to suppliers regarding a number of safety issues related to equipment, patients, and staff members. ACR, IAC, and The Joint Commission present monthly reports to CMS disclosing the accredited ADI suppliers; the reports include beginning and end accreditation dates for each supplier and the particular modalities for which accreditation is received.
Transmittal 380 provides guidance regarding the system parameters for the accreditation requirement. Particularly, the transmittal specifies the current enrollment procedures for newly enrolling ADI suppliers. The transmittal replaces its predecessor, Transmittal 373, reflecting recent changes to CMS-855I and CMS-855B brought on by the discontinuation of the use of code 95 in relation to ADI.
Effect of Changes on Newly Enrolling Physicians and Non-physician Practitioners
To initiate the enrollment process, a supplier must register through the Provider Enrollment, Chain and Ownership System (PECOS) available online or complete the designated CMS-855, ensuring to check the appropriate boxes in the ADI section of the document. The completed enrollment form should be mailed to the appropriate Medicare enrollment contractor. All Medicare enrollment contractors shall accept these applications from providers and suppliers who possess the new ADI accreditation. Subsequent to the submission of the application, the Medicare enrollment contractors will then verify whether the information on the application satisfies the current enrollment requirements. Further, the Medicare enrollment contractors will verify whether the supplier is included in the list of accredited individuals and organizations found at www.cms.hhs.gov/Medicareprovidersupenroll; the consistency of accreditation information found in section 2 of the appropriate CMS-855 completed by the supplier will also be evaluated. Upon approval of the supplier’s application, the Medicare enrollment contractors will enter the appropriate information into PECOS. The date of the filing will be used by the contractors as the effective date for ADI accreditation in PECOS.
Effect of Changes on Currently Enrolled and Accredited Suppliers
Physicians and non-physician practitioners who are currently enrolled in the Medicare program and are accredited by a CMS program recognized for this purpose do not need to take any action pursuant to Transmittal 380. The suppliers’ accreditation information will be automatically transmitted to CMS by these organizations and subsequently loaded into PECOS.
Crucial Dates for Suppliers of Advanced Diagnostic Imaging Services
A provider education article related to Transmittal 380 is anticipated in the near future. At that time, the article will be available at www.cms.hhs.gov/MLNMattersArticles.
Suppliers who submit claims for the TC of ADI services to Medicare must be accredited by one of the specified AOs by January 1, 2012 in order to receive reimbursement for claims related to services performed on or after this date. Additional information regarding the accreditation process pursuant to MIPPA may be obtained from the individual AOs as follows:
American College of Radiology (ACR)
1891 Preston White Drive
Reston, VA 20191-4326
Intersocietal Accreditation Commission (IAC)
6021 University Boulevard, Suite 500
Ellicott City, MD 21043
The Joint Commission
Ambulatory Care Accreditation Program
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
Adrienne Dresevic, Esq. graduated Magna Cum Laude from Wayne State University Law School. Practicing healthcare law, she concentrates in Stark and fraud/abuse, representing various diagnostic imaging providers, eg, IDTFs, mobile leasing entities, and radiology and multi-specialty group practices.
Carey F. Kalmowitz, Esq. graduated from NYU Law School. Practicing healthcare law, he concentrates on corporate and financial aspects, eg, structuring physician group practice transactions; diagnostic imaging and ancillary services, IDTFs, provider acquisitions, CON, compliance, and Stark and fraud/abuse.
The authors are founding members of The Health Law Partners, P.C. and may be reached at (248) 996-8510 or (212) 734-0128, or at www.thehlp.com.