United Healthcare
NEWLY UPDATED, 12/30/09 - UnitedHealth Group (UnitedHealthcare) has released an announcement stating: “UnitedHealthcare is committed to ensuring that all of our members have access to quality health care, including medical imaging services. We believe patients deserve assurance that equipment, technologists and physician practices are in compliance with professional society-developed performance standards for CT, MRI, PET, nuclear medicine/cardiology and echocardiography procedures. As previously announced, UnitedHealthcare will require accreditation as a condition of eligibility for reimbursement for these imaging services. Further, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) will require providers of advanced imaging services (CT, MRI, PET, nuclear medicine) to be accredited by January 1, 2012. Effective this date, accreditation will become a mandatory requirement in order to receive payment from Medicare for the technical component of imaging services. We are awaiting the final CMS publication that will describe their operational criteria, which we will review and consult with the accrediting agencies to determine if modifications are needed for our program to ensure alignment. As we strive to achieve operational consistency and effectiveness when new programs are introduced, UnitedHealthcare will not activate the claim denial component of the imaging accreditation program until further notice. We will communicate the new effective date, via formal letters, 90-days in advance of the activation. We will also communicate additional information about this program through the physician portal, UnitedHealthcare Online, and in future issues of the Network Bulletin. We remain committed to advancing the quality and safety of imaging services through the Imaging Accreditation Program and will keep you apprised of our revised implementation time frame. In the interim, we encourage you to continue your preparedness activities.”
Specific to echocardiography laboratories:
As published by UnitedHealthcare within its Frequently Asked Questions document, "What are the imaging procedures subject to accreditation? The following imaging procedures are subject to accreditation: CT, MRI, PET, nuclear medicine, nuclear cardiology and echocardiography. The most current and complete list of corresponding CPT codes is available on UnitedHealthcareOnline.com via Clinician Resources > Radiology > Imaging Accreditation.
Would you like to know more about the UnitedHealthcare requirement?
For the details and official guidelines from UnitedHealthcare, please
visit their website section for Imaging
Accreditation. [Go to UnitedHealthcareOnline.com >
Clinician Resources > Radiology, and select Imaging
Accreditation from the vertical menu bar on the left.] Get answers
to common questions about the UnitedHealthcare policy in Imaging
Accreditation: Frequently Asked Questions. >>
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