MIPPA/CMS Requirements

Accreditation as a Requirement for Medicare Reimbursement

When? As of January 1, 2012

Who?

All providers that bill under Part B of Medicare.
Private outpatient facilities only, NOT hospitals.

What? Nuclear, CT, MRI, Breast MRI and PET

Important: Medicare does not accept “applied”, “under review” or “provisional” accreditation. You will not receive Medicare reimbursement until you are granted accreditation. Applications both through the Intersocietal Accreditation Commission and the American College of Radiology require a 90 day review process! Are you prepared for the Medicare reimbursement requirements? Do you fully understand the implications to your Lab? Avoid loss of insurance reimbursement – ACT NOW!

10 Things You Need to Know About CMS/MIPPA Accreditation Requirements

1. Who needs to be accredited?
   Providers of the following tests:
   • Nuclear Medicine
   • CT
   • MRI
   • Breast MRI
   • PET

   The Medicare Improvements for Patients and Providers Act (MIPPA) calls for all providers that bill under Part B of the Medicare Physician Fee Schedule to be accredited in order to receive payment for the technical component of these services. Currently, the CMS/MIPPA mandates apply to private outpatient facilities only, NOT to hospitals.

2. What are the basic areas of CMS requirements?
   • Personnel qualifications for non-physician medical staff, medical directors, and supervising physicians
   • Image quality
   • Equipment performance
   • Safety standards for staff and patients
   • Quality assurance and quality control
3. What is we’re already accredited?
   Make sure you renew on a timely basis. And, even if your facility has received accreditation there are additional newly mandated requirements for CMS reimbursements as of Jan. 1, 2012. Your facility must be compliant with these requirements by the deadline:
   • Verification of personnel qualifications with primary source verification
   • Policy on patient record retention/retrieval
   • Policy on consumer complaints
   • Posted notice for patients listing consumer complaint contact information
   • Policy on staff and patient safety
   • Unannounced site visits from CMS or ACR
   • ACR must share accreditation information with CMS
   • No “under review” or “provisional” accreditation status
   • False or misleading information provided to an accrediting body to achieve accreditation can be used to initiate a federal fraud investigation
4. What happens if we miss the deadline?
   As of Jan. 1, 2012, reimbursements will only be made if a provider is fully accredited by one of the three CMS designated accreditation organizations:
   • (ACR) American College of Radiology
   • (IAC) Intersocietal Accreditation Commission
   • (JCAHO), Joint Commission.

   Medicare does not accept “under review” or “provisional” accreditation. Your lab will not receive Medicare reimbursement until you achieve full accreditation!

5. Are all three accrediting organizations offering the same CMS-mandated accreditation process?
   No. CMS did not establish a standard process for accreditation. The pricing, accreditation application, and review process differs among the three Accrediting Organizations.
6. How long does the accreditation process take?
   The review process with the accrediting organizations is usually 3 months. Things to think about:
   • It can take between 3 – 6 months preparing your lab to be ready for application submission. Sometimes longer if multiple staff members are involved.
   • It takes 3 months for the accrediting organization to process your application and make a decision.
   • It is common to receive provisional and/or delayed status initially. Additional time will be needed to address any concerns and re-submit to the accrediting organization.
   • Medicare will stop paying if you do not have full accreditation.
7. How do we get started?
   1. Call CardioServ for a free consultation 800-964-1372
   2. Click here to request more information.
   3. E-mail CardioServ at [email protected]

   Although the application may be completed by the labs directly we recommend hiring a consultant to ensure a quick and successful application submission.

   Visit the accrediting organizations websites to learn more about the standards and guidelines.

   • (ACR) American College of Radiology
   • (IAC) Intersocietal Accreditation Commission
   • (JCAHO) Joint Commission
8. What if we receive a deficiency?
   
   • CardioServ, LLC has dedicated staff that will assist you with your deficiencies.
   • You can also always contact the accrediting organization at any time and they will assist you with you deficiency.
9. Which accrediting organization should I choose?
   There are many factors to consider when seeking an accrediting organization. We recommend that you contact CardioServ, LLC at 800-964-1372 and a knowledgeable professional will listen to your Lab’s needs and recommend the accrediting organization that best fits your needs. Call today for your free consultation 1-800-964-1372
10. Are there requirements for echocardiography or vascular testing?
    Currently, echocardiography and vascular ultrasound are not considered advanced imaging modalities and accreditation is NOT required by CMS. However, in some states the medicare carrier and/or private insurers require either accreditation of the laboratory and/or songorapher credentialing. To see if this applies to your state or for more information, see our Echo Reimbursement and Vascular Reimbursement pages.

Avoid delayed or provisional statuses!

• Call CardioServ for a free consultation 800-964-1372
• Click here to request more information
• Email CardioServ at [email protected]