IAC Nuclear/PET | Application & Re-Application Tutorial
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 lab’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 Director’s strong suit is not paperwork, or if they do not have a lot of time to devote to a reaccreditation application, then either the Practice Manager / Department Director should oversee 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 to break it up into parts, and delegate those parts to responsible individuals. For example, in the IAC Nuclear Checklist 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.
Divide up the the information to be gathered 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, it is always a good idea for the Practice Manager / Dept. Director to proof-read the application and associated documents simply because two heads are always better than one and it’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 ICANL’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 – 6 Months…
Give yourself 3 – 6 months to prepare your (re)accreditation application. (at least 6 months for your first application)
For example, if your accreditation expires on December 31st, start working on the application somewhere between March 30th – June 30th. (You would 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 IAC Accreditation Checklist for Nuclear/PET. It lists everything you’ll need to compile for the application. Click on the image below to download the checklist.
- Getting all this documentation together, preparing new 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 ICANL’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. Your final reports should characterize perfusion and wall motion defects in a way that precisely reflects your images. You really don’t want to leave any room for the application reviewers 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.; 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.. ICANL’s “Application Review Findings” (which you will receive once accredited) reveal that they don’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 ICANL’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. This way you don’t have to go hunting through the Standards to find out which Standard(s) pertain to your 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 Standard Part B, 2.4.2B 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 are 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 a 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:
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 terminology 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 Cedar’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 terminology when characterizing perfusion and/or wall motion defects.
If you purchase reporting software, use our Guide & Checklist to 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 NucReporter consists of Automated Microsoft Word Templates.
It has a simple, fast & intuitive pop-up graphical user interface & 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 inside of 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 is our 238 ICANL error-checks with 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. 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 now virtually impossible to consistently comply with these new Standards without sophisticated structured reporting software.
Our automatic error checking algorithms have recently been updated to keep you 100% compliant with the New ICANL Standards for March 2017.
Keeps Your Referring MDs Referring to You:
It irritates referring MDs when they receive wordy, poorly structured, multiple page reports with extraneous and irrelevant information obscuring what is important:
- They must painstakingly scrutinize it to extract any relevant information
- They are at risk 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
- Pleasing to the eye
- Easy to digest quickly
- (For example, an Exercise Summary Section for a quick look at relevant stress test findings)
Complete, Concise & Comprehensive 1-Page Reports:
- ASNC-standardized report elements
- All ICANL required report elements pre-built into final reports
- 238 automatic error checks per template check for logical consistency and completeness
- The structure & error-checking give you peace of mind that you didn't forget anything
- Your patients are safe from errors in communication
Creates Reports Quickly, Easily & Inexpensively:
Quickly and easily produces high-quality reports
A very affordable 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 minutes and can be done by a Technologist, NP/PA/RA/RN, or MA
- Your personnel transcribe data from a carefully coordinated 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 Interface for Interpreting MDs
- Complete, yet simple; master it in minutes
- "Fast & super-easy to use after you've read about 7 studies" ~ Mark C. Goldberg, MD FACC
- Interpreting MD constructs by a few quick clicks
- Quick Normal 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 own custom sentences as you like.
- Protect your accreditation with ICANL, ACR, or JCAHO
- Please your referring MDs- concise, efficient, attractively laid out 1-page reports
- Protect against audits by Recovery Audit Contractors by 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 usually have you operational within 3 days
Protects You from Audits & Demonstrates AUC Fulfillment:
- Appropriate Use Criteria (AUC) is now a fundamental quality control measure will likely be used by insurance companies sooner than we realize to authorize reimbursement
- It behooves us to get familiar with AUC now and build it into our documentation
- Our "Indications" are specifically designed to show fulfillment of AUC, using language from the 2009 Appropriate Use Criteria
- This protects you from having to justify your decisions in the future
Every minute detail about the patient, the imaging protocol, the stress test, and the images is built into our templates and error-checked:
- Gives you peace of mind against future audits and site visits by accreditation agencies and RACs
ICANL’s Review Process
Case Study Pre-submission
Once you have finished your online application, the first thing you will prompted to do is to electronically “pre-submit” your case studies for approval before you submit your entire application.
ICANL’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 of 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 your case study selection appears correct, you may then formally submit the online application. 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
ICANL’s review process 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 “peer reviewers”; one is a physician, the other a technologist. 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 findings 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, CMS will not reimburse you for studies 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 don’t miss much.
Common Application Pitfalls 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 year accreditation cycle relevant to nuclear medicine
- Quality Assurance (You must submit your Quality Improvement Meeting Minutes)
- At least 2 yearly Quality Improvement Meetings 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 “mid”-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 staff’s required credentials in electronic (scanned to a PDF) form so that you can check their credential expiration dates at a moment’s notice.
- Also set reminders for yourself in your electronic calendar that begin 4 months before a given credential expires. 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 “X” months to renew their credential.
- Don’t stop pestering them until you have scanned their new credential into your folder system.
- This way you’ll never be out of compliance with requirements & you’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 make Quality Improvement studies 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. 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 lab’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 lab’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 & ½ years at a minimum. Nothing less than continual “audit-readiness” 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 – 6 months prior to the application submission date to get the reaccreditation application together.
- If you have any questions, feel free to contact us.
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