Not all accreditation is optional. CMS requires health care organizations to comply with federally regulated Conditions for Coverage (CfCs) to receive reimbursement. There are two ways that a health care organization can demonstrate compliance. They can either undergo a survey by a state agency on behalf of the federal government or be accredited by an approved national accrediting organization, the most popular being The Joint Commission (TJC).
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While CMS does not have specific imaging accreditation requirements for hospital-owned imaging, some commercial payers and states do have specific requirements for imaging reimbursement. Commercial payers including UnitedHealthcare, Aetna, and Blue Cross Blue Shield may require modality specific accreditation, depending on the particular plan. Adding another level of complexity, some states mandate accreditations for CT and MRI. (Editor's note: The Reading Room is published by Advisory Board, a division of Optum, which is a wholly owned subsidiary of UnitedHealth Group. UnitedHealth Group separately owns UnitedHealthcare.)
Non-hospital based imaging facilities billing under the Medicare Physician Fee Schedule (MPFS) have their own requirements under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). They must be accredited by The American College of Radiology, Intersocietal Accreditation Commissions, RadSite, or TJC to receive Medicare reimbursement.
While imaging programs must invest time and resources to achieve these mandatory accreditations, there are additional accreditations that imaging programs can pursue to distinguish themselves from competitors.
Make no mistake: These accreditations aren't cheap—ranging from $700 to $3,200 for a single modality. And in an environment where cost and quality pressures are ever present, it's time to think critically about whether or not to apply for a particular accreditation.
For these voluntary accreditations, imaging programs need to weigh the benefits and drawbacks of seeking accreditation.
What to consider when choosing an accreditation program
Accreditation isn't a one-fits-all strategy. Imaging leaders should select a program that provides the greatest return on investment.
Navigating accreditation can be complicated—plenty of options, differing payer requirements, and countless accreditation stipulations, not to mention significant and varying financial investments. When choosing an accreditation path, the following steps can help ensure the accreditation program fits into larger programmatic goals so you can leverage the accreditation's full value:
- Understand CMS, state, and commercial payer requirements that could affect your program's reimbursement;
- Establish goals for accreditation to maximize benefits. These goals can be related to your organization's marketing strategy, process improvement, quality control, patient safety, and more;
- Review how your program holds up against accreditation standards to understand the level of investment required;
- Size up the investment needed to apply for an accreditation. Review the cost of accreditation, resources required to apply, and process adjustments to ensure standards are met; and
- Develop a plan to reap the full benefits of being accredited. Have a plan for leveraging the accreditation once you've obtained it.
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