Meet Advanced Diagnostic Imaging Accreditation Requirements
Attention physicians, non-physician practitioners (NPPs), and independent diagnostic testing facilities (IDTF) supplying imaging services and submitting Medicare claims for the technical component (TC) of advanced diagnostic imaging (ADI) procedures: MLN Matters SE1122 provides assistance to help you meet the accreditation requirements established in Section 135 (a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
For you to furnish the TC of ADI services for Medicare beneficiaries, you must be accredited by Jan. 1, 2012 to submit claims with a date of service on or after Jan. 1, 2012.
ADI Accreditation Requirements
The secretary of the Department of Health and Human Services (HHS) is required by MIPPA to designate organizations to accredit suppliers that furnish the TC of ADI services. As required:
- ADI procedures include magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging, including positron emission tomography (PET).
- The MIPPA expressly excludes X-ray, ultrasound, and fluoroscopy procedures.
- Suppliers of imaging services include, but are not limited to, physicians, NPPs and IDTFs.
The three approved accreditation organizations are the American College of Radiology, the Intersocietal Accreditation Commission, and the Joint Commission. There are many quality standards for which you must be in compliance, and you will need to show compliance to the accreditation organization. According to SE1122, the quality standards at a minimum address:
- Qualifications of medical personnel who are not physicians;
- Qualifications and responsibilities of medical directors and supervising physicians;
- Procedures to ensure that equipment used meets performance specifications;
- Procedures to ensure the safety of personnel who furnish the imaging;
- Procedures to ensure the safety of beneficiaries; and
- Establishment and maintenance of a quality assurance and quality control program to ensure the reliability, clarity, and accuracy of the technical quality of the image.
The accreditation costs vary depending on the accreditation organization. On average, the cost for one location and one modality is approximately $3,500 every three years.
Medicare will deny claims for services, starting Jan. 1, 2012, for modalities that are not accredited. Denial code N290 Missing/incomplete/invalid rendering provider primary identifier will be used. Codes submitted for the TC will be denied if the code is not listed as “accredited.”
To find out about the accreditation process and helpful facts about ADI accreditation, see MLN Matters SE1122.
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