Nuclear Medicine Accreditation Overview:
Posted on Aug 4, 2014 by Jim McGee, BS CNMT NCT
MIPPA Explained; ICANL, ACR & the Joint Commission Compared
MIPPA & Reimbursement
In 2008, United Healthcare was the first insurer to require nuclear cardiology accreditation. Also in 2008, Congress enacted the Medicare Improvements for Patients and Providers Act (MIPPA) which went into full effect on January 1st, 2012.
MIPPA requires labs that bill for the technical component of advanced diagnostic exams (CT, MRI & Nuclear/PET) under Part B of the MPFS to be fully accredited by one of these 3 accreditation organizations: (Hospitals & hospital outpatient imaging centers are exempt from MIPPA accreditation requirements)
- The American College of Radiology (ACR)
- IAC (Nuclear/PET (ICANL), CT (ICACTL), MRI (ICAMRL)
- The Joint Commission
CMS will not issue payments to laboratories with “Under review” or “Provisional” accreditation statuses; you must maintain accreditation at all times.
Any interruption in full accreditation status can now lead to a near total loss of revenue, since many insurance companies now require nuclear cardiology accreditation also. (We have had customers who have lost over $100,000 in revenue due to ICANL denial of Accreditation because of final report deficiencies.)
(Echocardiography accreditation is not mandated by MIPPA, but many insurers such as United Healthcare require it.)
3 Accreditation Options
Disclaimer: the author’s only personal experience is successful accreditation & reaccreditation with the IAC (ICANL)
Formerly known as JCAHO, the Joint Commission is the largest U.S. hospital accreditation organization.
They may not be the best option for a non-hospital nuclear lab. The process of securing accreditation is somewhat daunting.
To even get a username and password to login to their website and start exploring accreditation, it is necessary to first call a representative and give out information about your lab.
Their website is confusing to navigate. It appears that their last set of standards was published around 2011 and there have been amendments published since then. You may have to piece the current requirements together yourself.
They accredit entire facilities only, so if you have a nuclear lab in a cardiology practice, you would have to accredit the entire cardiology practice, not just the nuclear lab.
They are also the most expensive option, costing $10,335 for 3 years (if your facility has under 5,000 visits per year).
If you have a lot of experience with the Joint Commission, and you need your entire practice to be accredited, they may be the best option for you. Otherwise you would probably end up spending quite a lot on a consultant to navigate their processes. In fact, they have their own consulting organization which is tied right in to their main website.
American College of Radiology (ACR):
This may well be the best option if your nuclear cardiology lab is part of a Radiology Practice.
The ACR Nuclear Medicine Accreditation Requirements are relatively short and straightforward (17 pages), however they do make frequent references to other sets of ACR Standards. If you are already tied into a Radiology Practice, you probably have all the pieces in place to relatively easily secure accreditation from them.
The ACR is highly focused on the quality of your cameras & images. They require the use of an imaging phantom, extensive involvement by a Medical Physicist for your application images, and Quality Assurance studies about consistency of interpretation between Interpreting Physicians.
Their application process is on a tight timetable: you must submit all application materials within 45 days of requesting the application itself, which is in paper format. Your fee is due when you request the application.
For a single camera nuclear lab, ACR accreditation will cost you $3,392 including a small SPECT phantom, plus Medical Physicist fees.
Intersocietal Accreditation Commission Nuclear/PET (ICANL)
Most cardiology practices use IAC Nuclear/PET (ICANL) for nuclear cardiology accreditation. ICANL is an organization comprised of representatives from an assortment of professional societies related to nuclear medicine and nuclear cardiology, such as the ACC, ASNC, SNMMI, SNMMITS, ASRT and others.
ICANL’s Standards & Guidelines are 47 pages long, and they do not refer to any other ICANL publications.
They are focused on your lab as a whole; the overall quality of your lab & your final report quality. They want to know that all aspects of your examinations are performed properly, and they want the exam procedure & results to be precisely documented in your final reports.
ICANL requires you to maintain a policy and procedure manual that contain guidelines & protocols regarding the way you do just about everything. They want it to be sufficiently complete and detailed so that if all of your personnel were replaced tomorrow, new staff could pick up smoothly just from the policy & procedure manual. A typical policy and procedure manual is a good solid inch thick (of paper).
One thing you should be aware of regarding ICANL is that their Report Requirements, for Nuclear
If you go with ICANL & do Nuclear Cardiology, you are going to need structured reporting software.
Our Template Reporting System is particularly designed to produce ICANL Compliant Reports through comprehensive ICANL Error-Checking & Corrective Messaging Algorithms.
If you’d like to download & work through a trial report (which takes ~ 5 minutes), click here.
ICANL vs ACR Table
|Underlying Concept & Focus of Review:||Technical & Interpretive Quality of Your Lab as a Whole: Overall exam quality & Final report quality||Focus is on the quality of your imaging equipment & technology|
|Developed by:||A multi-speciality organization||Radiologists for radiology facilities|
|Accreditation granted per:||Body system||Camera Unit|
|Protocols reviewed:||Many laboratory procedures & protocols, covering just about everything ICANL Application Checklist||Focus is on imaging protocols & imaging equipment quality control protocols|
|Quality Assurance Studies Required:||Ongoing Administrative, Technical & Interpretive Quality Improvement Studies (including Appropriate Use Criteria) +Departmental Conferences (in-services ,etc.)||Physician peer review + phantom testing|
|Case Studies:||5 Case Studies (1 Normal + 4 abnormal): Images, final reports, stress worksheets & ECG tracings||2 Normal studies: Images + final reports|
|Medical Physicist:||Must be consulted for pregnant / breastfeeding patients & radiation safety program||More extensive involvement is required in lab & in application process|
|Phantom Studies:||Optional||Required (Phantom is available for $1,392)|
|Application / timetable:||Online application may be updated at your convenience; old application data is available to you. Fee is due upon final submission of application.||All materials must be submitted within 45 days of your application request. Paper application. Fee is due upon request for the application.|
|Cost:||$3,300 for Nuclear Cardiology only ($3,800 for Comprehensive Nuclear Medicine) + $1,200 each additional site (sites 2-3) + $960 each additional site (sites 4-10) IAC Accreditation Cost Calculator||$1,300 Facility Fee + $700 per camera + $1,392 small SPECT phantom + Medical Physicist Fees|