New Jersey
"While it is not the Carrier's intention or jurisdiction to
credential providers, Medicare does expect a satisfactory level
of competence from providers who submit claims for services rendered.
It is well known that substandard studies often lead to preventable
repetition of studies and overutilization of services.
The acceptable levels of competence are outlined as follows:
For the technical portion, an acceptable level of competence
is fulfilled when the image acquisition is obtained under any one
of the following conditions:
a. The service is performed by a physician; or
b. The service is performed by a technician who is credentialed
as either a Registered Diagnostic Cardiac Sonographer (RDCS) through
the American Registry of Diagnostic Medical Sonographers or as
a Registered Cardiac Sonographer (RCS) through the Cardiovascular
Credentialing International; or
c. The service is performed at a laboratory (e.g. office, IDTF),
credentialed by the Intersocietal Commission for the Accreditation
of Echocardiography Laboratories (ICAEL).
For the professional portion, an acceptable level of competence
is fulfilled when the interpretation is performed by a physician
meeting any one of the following requirements:
a. The physician is board certified in Cardiovascular Diseases;
or
b. The physician has Level II training in transthoracic echocardiography,
as defined by the American College of Cardiology/American Heart
Association/American College of Physicians Task Force on Clinical
Competence in Echocardiography, or the equivalent of Level II
training as set forth in that document; or
c. The physician provides the interpretation in conjunction with
a study that is performed at a laboratory that is accredited by
the Intersocietal Commission for the Accreditation of Echocardiography
Laboratories (ICAEL) and that is subject to such laboratory's
quality assurance policies and procedures; or
d. The physician has staff privileges to interpret echocardiograms
at a hospital that participates in the Medicare program.
The submission of claims for echocardiography will be considered
an attestation that both the technical and professional components
of the service were provided within the context of the above stated
credentials. However, a grace period of two years will be allowed
for providers to acquire the necessary training."
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