How to Get & Keep ICANL Accreditation
Posted on August 24th, 2014 by Jim McGee, BS CNMT NCT
This tutorial will walk you through the most important practical aspects of successfully obtaining and keeping IAC Nuclear/PET (ICANL) accreditation as a Nuclear Cardiology laboratory.
It is broken down into 8 sections.
If you have any remaining questions about IAC Nuclear / PET accreditation after reading this, feel free to contact us.
If your lab chooses to do the re-accreditation application on it’s own, then usually your labâ€™s Technical Director (chief nuclear medicine technologist) will be primarily responsible for ICANL compliance and will oversee the accreditation / reaccreditation application.
However, the Technical Director should work very closely with your Medical Director on this. Putting together an entire application and related materials is a very time-consuming, detail-intensive process. You really can’t get anything wrong without the application reviewers noticing it.
If your Technical Directorâ€™s strong suit is not paperwork, or if they do not have a lotÂ of timeÂ to devote to a reaccreditation application, then either the Practice Manager / Department Director should overseeÂ the application, or you may well want to hire a reputable and experienced Accreditation Consultant to guarantee that everything goes smoothly.
It is ideal for whoever is overseeing the application toÂ break it upÂ into parts, and delegate those parts to responsibleÂ individuals. For example, in theÂ IAC Nuclear ChecklistÂ shown later in this tutorial, Step 2 consists of a lot of information / paperwork that needs to gathered and scrutinized to make sure it is correct.
DivideÂ up the the information to be gatheredÂ among your personnel, and schedule a meeting with all of them in a month or two to review what they have collected and make sure it is complete & meets the Standards.
Also, once the application is complete, Â it is always a good idea for the PracticeÂ Manager / Dept. Director to proof-readÂ the application and associated documents simply because two heads are always better than one and itâ€™s easy to miss minor but important details.
If your lab is starting your policy & procedure manual from scratch, and applying for accreditation for the first time, you may well want to hire an accreditation consultant to help you get your policy and procedure manual together. Or, you could create your own policy and procedure manual by customizing ICANLâ€™s sample documents to represent your lab.
If you are missing any necessary elements of your policy & procedure manual, ICANL probably has it here. However, you must customize these to precisely correspond to your unique lab.
3 – 6Â Months…
Give yourself 3 – 6 months to prepare your (re)accreditation application. Â (at least 6 months for your first application)
For example, if your accreditation expires on December 31st, start working on the application somewhere betweenÂ March 30th – June 30th. (You wouldÂ submit your re-accreditation application 3 months before your current accreditation expires, i.e. September 30th.)
You should be continually maintaining your policy & procedure manual, staff credentials, and other records, but you still should give yourself plenty of time to collect everything you need & go over it with a fine tooth comb.
A great way to get started with this whole process is to download the super-helpful IACÂ Accreditation Checklist for Nuclear/PET. It listsÂ everything youâ€™ll need to compile for the application. Â Click on the image below to download the checklist.
- Getting all this documentation together, preparing newÂ documentation, compiling multiple policies into single PDFs, making sure it is all correct, and entering / uploading it into the ICANL online application takes a lot of time.
- Again, it is a great idea to divide up the tasks in the checklist and delegate them among responsible personnel:
Case Study Selection / Preparation
Also, choosing and preparing your case studies can take a lot of time, for the following reasons: First, your 5 case studies have to comply with ICANLâ€™s specifications:
- 1 normal
- 1 ischemia
- 1 infarction
- 1 abnormal wall motion
- 1 abnormal stress test
- Cases must represent as many Interpreting MDs as possible (including your Medical Director).
Second, they have to represent your best work. Â Your final reports should characterize perfusion and wall motion defects in a way that precisely reflects your images. Â You really donâ€™t want to leave any room for theÂ application reviewersÂ to disagree with your final report.
Third, you will have to convert quite a few digital image files from your processing workstation into formats ICANL will accept, and then archive them onto CD/DVDs or USB drives and make sure everything is properly labeled, etc.;Â this takes time.
Your case study images should be without artifact, the stress worksheet must be properly filled out, the ECG tracings should be without artifact, and the final report must accurately reflect and synthesize the stress worksheet, ECG tracings & images.
Remember that your case studies are going to be reviewed by the top Nuclear Cardiologists in the US. Any motion should be corrected properly, your slices should be lined up properly & your contours should be drawn correctly on quantitative processing programs such as Cedar’s, Emory Toolbox, 4D-MSPECT, etc.. ICANLâ€™s â€œApplication Review Findingsâ€ (which you will receive once accredited) reveal that they donâ€™t miss a thing- they will comment on the slightest hint of a misaligned slice.
You should submit your accreditation application 3 months before you need to be accredited / your accreditation expires.
The online application consists of a series of questions where you attest that you are following ICANLâ€™s Standards. For most of your attestations, you will upload corresponding documentation that demonstrates your compliance with the applicable standard (copies of lab-specific policies & protocols, meeting minutes, licensure & certification documentation, etc.)
One very nice feature of the online application is that for each question / upload, the relevant Standard number is listed in bold print by the question.Â This way you don’t have to goÂ hunting through the Standards to find out which Standard(s) pertain to yourÂ uploads/protocols. And, even better, if you hover your mouse pointer over the standard number, the Standard appears in a pop up window.
See the pop-up for StandardÂ Part B,Â 2.4.2BÂ in the screen shot below:
These Sections are Submitted Online:
- Facility Overview
- Personnel & Supervision
- Medical Director & Medical Staff (Credentials, CMEs, etc)
- Technical Director & Technologists (Credentials, CEs, etc)
- Other Patient Care & Ancillary Personnel (Credentials, etc)
- Radiation Safety & Other Patient Safety
- Examinations & Procedures
- Instrumentation QC
- Preventive Maintenance
- Protocols (General & Clinical)
- Case studies (1 Normal, 4 Abnormal)
- Final Reports
- Stress Worksheets & ECG tracings
- 2 additional final reports per Interpreting MD (including Medical Director)
- Quality Improvement (QI Plan & Meeting Minutes)
- Legal Attestations & Agreements
These Materials areÂ Mailed in:
- CD/DVDs or USB drives:
- Case studies (1 Normal, 4 Abnormal):
- Final reports
- Digital image files
- Exam worksheets and ECG tracings
- Case study final reports must represent as many Interpreting MDs as possible, including your Medical Director
- Camera quality control images
- Uniformity floods
- Linearity floods
- Center of Rotation QC
- Paper format:
- Signed Legal Attestations & Agreements
- Check (or can pay online)
ICANL has extremely high standards for nuclear cardiology final reports. This has been a notoriously difficult aspect of successfully attaining ICANL accreditation.
One of the biggest reasons nuclear cardiology labs receive negative accreditation decisions from ICANL is aÂ lack of compliance with their final report standards.
To view the latest research about IAC Nuclear/PET report non-compliance, click on the image below:
Are You Compliant? Use Our Definitive Guide & Checklist for IAC Nuclear/PET Report Compliance
The rawÂ ICANL report standards can be hard to follow.
Our Easy-to-Understand Guide & ChecklistÂ make it simpleÂ for you to see exactly how well you are complying with ICANL Reporting Standards:
Guide & Checklist for IAC Nuclear/PET Report Compliance
Non-compliant reports are the #1 cause of accreditation (reimbursement) lapses.
See if you're at risk & how to protect yourself.
Get Your Guide & Checklist - Are You a:
Here’s a sample page from our Guide & Checklist:
Structured Reporting Software
It is virtually impossible to consistently produce compliant reports using voice dictation or simply typing up reports using a template in a text editor.
To consistently & accurately interpret nuclear cardiology exams using appropriate standardized terminologyÂ requires the use of precisely programmed structured reporting software.
There are quite a few options available with respect to structured reporting software:
- Add-ons to image quantification software such as Cedarâ€™s or Emory Cardiac Toolbox
- Add-ons to isotope tracking software
- Web based programs
- Structured reporting solutions such as our own
Be aware that many commercial solutions are not truly ICANL compliant. Or, they do not use correct terminologyÂ when characterizing perfusion and/or wall motion defects.
If you purchase reporting software, use our Guide & Checklist toÂ make certain that it conforms to current ICANL Reporting Standards and uses ASNC-standardized terminology.
NucReporter SPECT/PET MPI Reporting Software
Quick, Simple & Easy Reporting Software:
Our NucReporterÂ consists of Automated Microsoft Word Templates.
It has aÂ simple, fast & intuitiveÂ pop-up graphical user interface &Â sophisticated algorithms that create perfect reports every time.
Normal images take about 33 seconds of an Interpreting MD's time:
All data entry and program execution happens insideÂ ofÂ the Word document; thus the only system requirement is a PC with Word 2010 or newer.
You save your reports as PDFs & easily upload or scan into any modern EMR.
The thing that sets our software apart Â is ourÂ 238 ICANL error-checks withÂ corrective messaging algorithms.
They make it almost impossible for your staff to produce non-ICANL-compliant reports.
Our solution is the most affordable and easiest to learn & use. Â You can be up & running less than a week from now.
Keeps You Compliant with the New 2017 ICANL Standards:
The New ICANL Standards which are effective March 15th, 2017 have added a number of New Reporting Requirements.
It is nowÂ virtually impossible to consistently comply with these new Standards without sophisticated structured reporting software.
Our automaticÂ error checking algorithms have recently been updated to keep you 100% compliantÂ with the NewÂ ICANL Standards for March 2017.
Keeps Your Referring MDs Referring to You:
It irritatesÂ referring MDsÂ when they receiveÂ wordy, poorly structured, multiple pageÂ reports with extraneous and irrelevant information obscuring what is important:
- TheyÂ mustÂ painstakingly scrutinize itÂ to extract any relevant information
- They areÂ at riskÂ of missing important details, or even an entire page
Many nuclear cardiology reports are unnecessarily more than one page, reporting information in non-standard terminology that is scattered all over the place in a manner lacking order and coherence.
Referring MDs appreciate you when you send them a clear and precise 1 page document that carefully presents all of the relevant facts in an well-ordered and concise fashion:
- Intuitively Structured
- Concise 1-page reports
- PleasingÂ to the eye
- Easy to digestÂ quickly
- (For example, anÂ Exercise Summary SectionÂ for a quick look at relevant stress test findings)
Complete, Concise & Comprehensive 1-Page Reports:
- ASNC-standardized reportÂ elements
- All ICANL required report elements pre-built into final reports
- 238 automaticÂ error checksÂ per template check for logicalÂ consistencyÂ andÂ completeness
- TheÂ structureÂ &Â error-checkingÂ give youÂ peace of mindÂ that you didn't forget anything
- YourÂ patients are safeÂ from errors in communication
Creates Reports Quickly, Easily & Inexpensively:
QuicklyÂ andÂ easilyÂ produces high-quality reports
AÂ very affordableÂ one-time fee licenses you to use the software "forever" - no recurring fees to decrease your profitability.
Your price is dependent on your volume of studies per year- now every lab can afford exceptional final reports.
You can even pay for your perpetual license key in 6 monthly installments.
Demographics, Imaging Protocol & Stress Sections:
- Takes 2 - 2.5 minutesÂ and can be done by a Technologist,Â NP/PA/RA/RN, orÂ MA
- Your personnel transcribe data from a carefully coordinatedÂ 1-page Stress Worksheet
- Technologists who regularly enter this data become more in tune with clinical aspects of nuclear cardiology & their patients, thus increasing their value to their practice or department
Image Interpretation Section:
- Simple Graphical User InterfaceÂ for Interpreting MDs
- Complete, yet simple;Â master it in minutes
- "Fast & super-easy to use after you've read about 7 studies" ~ Mark C. Goldberg, MD FACC
- Interpreting MD constructs byÂ a few quick clicks
- Quick NormalÂ report feature: ~33 seconds for normal reports
- Abnormal Images take less than 1 minute
- Accomodates preferences of multiple Interpeting MDs:
- Pre-load with as many of your ownÂ custom sentences as you like.
- ProtectÂ yourÂ accreditationÂ with ICANL, ACR, or JCAHO
- Please your referring MDs- concise, efficient, attractively laid outÂ 1-page reports
- ProtectÂ against audits byÂ Recovery Audit ContractorsÂ byÂ documenting every detail
Easy to Learn & Get Up & Running:
- Get a free, fully functioning 30 Day Trial & use it to create actual reports
- Over 20 concise Online Video Tutorials cover every aspect of use & customization
- We can usuallyÂ have you operationalÂ within 3 days
Protects You from Audits & Demonstrates AUC Fulfillment:
- Appropriate Use Criteria (AUC) is now a fundamentalÂ quality control measure will likely be used by insurance companies sooner than weÂ realizeÂ to authorize reimbursement
- It behooves us to get familiar with AUC now and buildÂ it into our documentation
- OurÂ "Indications" are specificallyÂ designed to show fulfillment of AUC, using language from the 2009 Appropriate Use Criteria
- ThisÂ protects youÂ from havingÂ to justify your decisions in the future
Every minute detailÂ about the patient, the imaging protocol, the stress test, and the images is built into our templates and error-checked:
- Gives youÂ peace of mindÂ against futureÂ auditsÂ andÂ site visitsÂ by accreditation agencies andÂ RACs
ICANL’sÂ Review Process
Case Study Pre-submission
Once you have finished your online application, the first thing you will prompted to do is to electronically â€œpre-submitâ€ your case studies for approval before you submit your entire application.
ICANLâ€™s case study requirements are quite particular, so they want to avoid you waiting a long time for them to review your application, only to discover that your case study selection did not meet their requirements. This aspect of the online application is new in 2014.
This pre-submission simply consists ofÂ pushing a button, and all of the information about your case studies that you entered in the application, and the corresponding final reports which you uploaded, will be transmitted to ICANL for initial approval. ICANL will notify you within 2 business days via email whether or not your case study selection appears to be correct.
Their initial acceptance of your case study selections is not a guarantee on their part that your case studies are adequate.
Electronic Submission & Mailed Materials
After IAC Nuclear/PET notifies you that yourÂ case study selection appears correct,Â you may then formally submitÂ the online application.Â You have 5 days after submitting your online application to mail in:
- Case study materials (CD/DVDs or USB drives)
- QC Images
- The signed application
- Signed attestations by the Technical Director & Medical Director
- Your check (You may also pay by credit card)
You will receive a letter within a week or so from ICANL, notifying you that your application has been received & when you may expect their final decision (the entire review process usually takes 12-16 weeks).
IAC Nuclear/PET Review Process
ICANLâ€™s review processÂ consists first of an in-house review by ICANL staff, where they examine your entire application for completeness and appropriateness. They will notify you of any obvious deficiencies in your application.
After that, your application is sent to two qualified â€œpeer reviewersâ€; one is a physician, the other a technologist. Â These peer reviewers have four weeks to conduct an in-depth analysis of the clinical components of your application, including case study materials. They record their comments and recommendations and submit their findingsÂ to the IAC Nuclear/PET Director of Accreditation. The Director reviews their findings and compiles them for the Board of Directors.
The final step is a meeting wherein the IAC Nuclear/PET Board of Directors discusses and reviews all of the previously compiled documentation, and renders a decision regarding your application. You will receive your notification of their decision shortly after the Board meeting. If there are substantial deficiencies with your application, accreditation will be delayed until you rectify them.
If there is any lapse in accreditation,Â CMS will not reimburse you for studiesÂ done during the lapse (not even retroactively once accreditation has been achieved.) If the board grants you accreditation, they will make your Application Review Findings available on their website. These findings contain all of their comments about your application, good and bad.
They may note some deficiencies on your application that were not significant enough to warrant a delay in accreditation. These deficiencies must be corrected by the time of your next audit, site-visit or reaccreditation application. They will be specifically looking for these deficiencies to be rectified.
ICANL will extend a grace period of 60 days beyond your accreditation expiration date if you are already accredited, have submitted your re-accreditation application well ahead of your expiration date, and have shortcomings with your application. They will work with you to correct application shortcomings and successfully achieve accreditation.
The ICANL staff are super friendly and have your best interest at heart; they will do everything they can to make sure your lab meets the requirements to secure accreditation in a timely manner; this is their goal.
On the other hand, they are the authorities in nuclear medicine, & they essentially represent the government and its requirements: you must take them very seriously and be diligent to precisely follow all of their policies, procedures & guidelines.
They pay very close attention to every detail of your application and submission materials, and they donâ€™t miss much.
Common Application PitfallsÂ Include:
- Final report quality
- Case study problems
- Again, make sure your image quality, interpretations, and final reports are of the highest quality.
- Organizational issues
- The Medical Director must be a truly involved, contributing member of your staff.
- One thing that ICANL is recently cracking down on: your Medical Director must now regularly interpret studies and sign final reports.
- The ICANL board has not determined a lower limit for how many studies the Medical Director must read, but it must be on a regular basis. Monthly should suffice.
- Insufficient CMEs & CEs
- Physicians & Technologists need 15 credits per 3 yearÂ accreditation cycleÂ relevant to nuclear medicine
- Quality Assurance (You must submit your Quality Improvement Meeting Minutes)
- At least 2 yearly Quality Improvement MeetingsÂ per year
- Administrative, Technical & Physician Performance studies
- At least 1 study in each area each year
- Appropriate Use Criteria Study 1x / 3 years
- This counts as Administrative & Physician Performance QI for that year
- At least 4 Departmental Conferences /year:
- In-services, safety topics, technical issues, improvements
- All staff must attend 50% of Departmental Conferences
- Protocols (Imaging, Stress Testing, Radiation Safety, Administrative, etc.)
- Apply for reaccreditation every 3 years
- Stay prepared for â€œmidâ€-cycle random site visits or audits (one of these will happen)
- Keep your policy and procedure manual current with changes at your lab
- Keep policy and procedure manual current with updates to the ICANL Standards
- Keep all licenses, certifications & CME/CE requirements current:
- A good practice is to compile all of your staffâ€™s required credentials in electronic (scanned to a PDF) form so that you can check their credential expiration dates at a momentâ€™s notice.
- Also set reminders for yourself in your electronic calendar that begin 4 months before a given credential expires. Â Repeat the reminders 1x / month after that.
- Each time you get one of these reminders, send an email or otherwise communicate with that staff member that they have â€œXâ€ months to renew their credential.
- Donâ€™t stop pestering them until you have scanned their new credential into your folder system.
- This way youâ€™ll never be out of compliance with requirements & youâ€™ll never get blamed for somebody not renewing their own credentials on time (can you tell this happened to me?)
- Keep up your Quality Improvement Program & minutes
- ICANL has a wealth of Quality Improvement tools on their website that makeÂ Quality Improvement studiesÂ so much easier.
- They have numerous, excellent QI spreadsheets that tell you exactly what data to collect, what the thresholds for error are, they give you space to enter your results, then they calculate your results for you!
- They are a fantastic resource; you can even do a cardiac catheterization correlation very easily,
- Stay in compliance with all regulatory authorities
- Notify the IAC of any changes in:
- Ownership or Address
- Change of Medical Director or Technical Director
Random Site Visits and Mid-cycle Audits
You will either be audited or site-visited once during your 3 year accreditation cycle.
If you are not randomly selected for a mid-cycle site visit, your facility will be notified of an audit. Â You will have 30 days to submit items such as the following:
- Final reports
- Case studies
- QI meeting minutes
- Licensing & credential documentation
- Any changes in your labâ€™s operations, policy and procedure manual, etc.
- Equipment changes & related protocol updates
- Changes in personnel
- Medical Director and Technical Director confirmation
- Facility information
- Attestation of maintaining compliance regarding correction of delay deficiencies (if applicable)
Failure to submit the requested audit information would result in suspension or potential revocation of your labâ€™s accreditation, which means you would have to re-apply entirely.
Site Visits (Labs are randomly selected for this)
- You will be given a 3 month time window during which the site visit may occur
- You are responsible to notify the IAC about the availability of key staff during that timeframe
- The site visitor will be on site for about 4-6 hours and:
- Have access to patient records
- Inspect facility policies and procedures
- Inspect Quality Improvement minutes & records
- Review any other pertinent information
- Observe patient testing and procedures
- Interview the Medical and Technical Directors
- Here is a sample site visit checklist that site visitors may use
- ICANL pays for random site-visit expenses
- If you are site-visited for cause, you must pay for the site visit
In summary, maintaining ICANL accreditation requires a responsible individual to be steadily diligent, paying regular attention to ICANL compliance.
Your nuclear cardiology lab will be scrutinized every 1 & Â½ years at a minimum. Â Nothing less than continual â€œaudit-readinessâ€ is required. Some things to monitor regularly include:
- Final Report Compliance
- Expiration of Credentials
- Quality Improvement Meetings and Minutes
- Policy & Procedure Manual changes as needed to reflect ICANL Standards Changes or Changes in your Protocols
- Compliance with all Regulatory Authorities
In addition to this, the person who is responsible for the reaccreditation application should be given / give themselves 3 – 6Â months prior to the application submission date to get the reaccreditation application together.
- If you have any questions, feel free to contact us.
Do you have any questions or comments on the process of accreditation?
I’d love to hear your comments.Â Enter your comments below.