Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

PAP249

Imaging Accreditation


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/February 2014
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Imaging Accreditation

Purpose and Statement of Intent

This policy is intended to promote reasonable and consistent quality and safety requirements for providers of imaging services.  We established these requirements to describe the accreditation and certification conditions a person might associate with high-quality imaging services.  We hope to establish an environment where qualified operators perform imaging studies using appropriate equipment and techniques and where qualified physicians interpret images. 

These requirements apply to all non-hospital providers of advanced imaging services.  They supplement the requirements for facility providers and physicians as contained in the Facility, Physician and Clinic Agreements. As of January 1, 2014, all non-hospital providers of advanced imaging services are required to register in the AIM OptiNet system in order to receive the higher compensation for the advanced imaging services. Clinics that complete registration after January 1, 2014, will be effective the first of the following month of notification of complete registration is received by your provider network management specialist by the 15th of the prior month.

The OptiNet Registration can be accessed through the provider portal at www.bcidaho.com.

Specific Requirements for Physician and Facility Imaging Providers

  • Physician or clinic providers that use advanced imaging equipment in their practice to diagnose and treat their own patients within their own specialty area of practice may not accept referrals from other providers for the purpose of performing diagnostic imaging tests for other providers’ patients.
  • Facility providers must be certified by Medicare as an Independent Diagnostic Testing Facility (IDTF) or radiology clinic.  These facilities may accept referrals from community physicians.  These facilities must be available for diagnostic imaging services for a minimum of 40 hours per week and have images available after hours.

General Requirements for Imaging Providers

  • All imaging providers must obtain accreditation by the ACR (American College of Radiology) or the Intersocietal Commission for the Accreditation of Magnetic Resonance Laboratories (ICAMRL) for MRI if performing MRI services.
  • The imaging equipment used must be appropriate for the study and must produce an image of sufficient clarity and detail to support proper diagnosis and treatment.
  • Blue Cross of Idaho may request a review of imaging studies or equipment as part of its routine quality review efforts or in response to a pattern of repeat studies suggestive of problems with equipment or technique. An external independent organization selected and reimbursed by Blue Cross of Idaho will perform such reviews. 
  • All providers billing for the global or professional component of an imaging service must complete a written interpretation of the study (an imaging report) within three business days from the date of service.  A written report is defined as a report; separate from the clinical note, that contains a thorough evaluation of the entire image with a description of the procedure, pertinent anatomy, findings, and limitations.  The written report must be signed by the interpreting physician, and forwarded to the ordering provider if different from the servicing provider.
  • All imaging providers must have a documented Quality Control Program inclusive of both imaging equipment and film processors.
  • All imaging providers using equipment producing ionizing radiation must have a documented radiation safety program and as low as reasonably achievable (ALARA) program.
  • All imaging providers using equipment-producing ionizing radiation must have a current (within three years) letter of state inspection, or calibration report, or American Board of Radiology (ABR) certified medical physicist’s report. We will make exceptions to “current state inspection” if lack of inspection is documented as a delay by the state. 
  • All imaging providers must have qualified technologists, state certified and registered by The American Registry of Radiologic Technologists (ARRT), American Registry for Diagnostic Medical Sonography (ARDMS), Certified Nuclear Medical Technologist (CNMT) or Nuclear Medicine Technology Certification Board (NMTVB). 
  • All imaging providers must ensure that a radiologist or licensed physician with credentials in the specialty of the requested diagnostic test is available for immediate consultations to optimize testing.
  • Providers may request provisional acceptance under the Blue Cross of Idaho accreditation and certification program if they are establishing a new practice, practice location, or area of specialty and are actively pursuing compliance with these requirements.  Blue Cross of Idaho will respond promptly to such requests.
  • Blue Cross of Idaho will only reimburse providers for diagnostic imaging services if the services are provided on imaging equipment owned by the provider or leased by the provider on a full-time basis.  Owned or leased on a full-time basis is defined as (a) the provider has possession of the equipment on the provider`s property and the equipment is under the provider`s direct control (b) the provider or group practice and only the provider or group practice uses the equipment and (c) financing of the equipment is not established on a per-use or similar basis.  Blue Cross of Idaho does not intend items (a) and (b) to prevent providers from pooling resources to acquire shared imaging equipment; however, each provider must meet the established requirements as described herein. 
  • Direct supervision means the described provider is present at the practice site and immediately available to furnish assistance and direction throughout the performance of the procedure.
  • All imaging providers are subject to unannounced site inspections by Blue Cross of Idaho.  Those providers who do not meet the above requirements may be subject to denial, reimbursement or contract termination.

Requirements Specific to Nuclear Cardiology

  • Nuclear cardiology practices must employ at least one physician who specializes in diagnostic imaging, nuclear medicine or has received certification by the Certification Board of Nuclear Cardiology (CBNC) or Core Cardiology Training Symposium (COCATS) Training.
  • Nuclear cardiology imaging systems must have the capability of assessing both myocardial perfusion and contractile function (ejection fraction and regional wall motion).
  • A licensed physician who has a current Advanced Cardiac Life Support (ACLS) certification must directly supervise cardiac stress tests.
  • Nuclear cardiology practices must provide a copy of a Radioactive Materials License that indicates the practice address and the name of the nuclear cardiology physician(s) performing and/or interpreting nuclear cardiology studies.  The person on the license must be a member of the billing practice.
  • Nuclear cardiology practices must use a technologist certified in Nuclear Medicine through the ARRT, Certified Nuclear Medicine Technologist (CNMT) or Nuclear Medicine Technology Certification Board (NMTCB), or licensed by the state in nuclear medicine technology.
  • Nuclear cardiology practices must achieve accreditation by ICANL (Intersocietal Commission for the Accreditation of Nuclear Cardiology Laboratories) or the ACR (American College of Radiology) within two years of Provisional acceptance in the Privileging Program.
     

Requirements Specific to Positron Emission Tomography (PET)
PET must be performed at a practice site that meets the following criteria:

  • Owned or operated by a comprehensive cancer treatment center; or
  • Part of a facility that accepts referrals from community physicians, is available for diagnostic imaging services a minimum of 40 hours per week, has images available after hours, and has multiple modalities such as:
  • Plain Films or DEXA (either or both count as one)
  • General or OB/GYN Ultrasound (either or both count as one)
  • Peripheral Vascular (PV) Ultrasound
  • Echocardiography/Stress Echocardiography (either or both count as one)
  • Mammography
  • Computed Tomography (CT)
  • Magnetic Resonance Imaging/Angiography (MRI/MRA)
  • Fluoroscopy
  • Nuclear Medicine/Nuclear Cardiology
  • Positron Emission Tomography (PET)

Referrals to these facilities are usually for more complex diagnostic purposes that require centralization and coordination of tests for diagnostic purposes.

Requirements for Professional Provider Telemedicine Privileging
Practice locations are not required to have an on-site radiologist or other licensed physician with credentials in the specialty of the requested diagnostic test if they utilize telemedicine whereby an appropriate physician specialist reads and interprets the image remotely; however, the practice location must ensure the following requirements are met:

  • The practice location must have a physician available for patient, referring physician and teleradiologist consultation during normal business hours.
  • The practice location must ensure a physician or technologist with current ACLS or ARLS certification is on-site when contrast enhanced procedures are performed.
  • The telemedicine physician must be Idaho licensed, or in the case of states bordering Idaho, in the state where the imaging site is physically located.
  • The telemedicine physician must be available for consultation with the imaging practice and ordering physician during the practice location’s normal business hours.
  • Images must be interpreted within 24 hours of the time the test is performed, and the interpreting provider must be available for real-time discussion with the ordering physician or imaging technician if requested.


Policy History

Date Action Reason
February 2014 Revised Updated registration requirements as of Jan 1, 2014
November 2013 Revised Updated to note all non-hospital providers of advanced imaging services are required to register
September 2011 Revised Language Update
July 2009 Revised Update to guidelines
February 2009 Revised Update to guidelines
May 2008 Revised Update to guidelines

Search for Policies

Policy Feedback