ACCREDITATION IMMINENT FOR MEDICARE ADVANCED DIAGNOSTIC IMAGING SUPPLIERS
By Nina Adatia
Beginning January 1, 2012, all suppliers who intend to bill the Medicare program for the technical component of advanced diagnostic imaging (ADI) services that are paid under the Medicare physician fee schedule must be accredited by a CMS-approved national accrediting organization.
Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) amended section 1834(e) of the Social Security Act and required the Secretary of the Department of Health and Human Services (the Secretary) to designate organizations to accredit suppliers that furnish the technical component of ADI services. Suppliers include, but are not limited to, physicians and non-physician practitioners, including clinics, and independent diagnostic testing facilities (IDTF). MIPAA specifically defines advanced diagnostic imaging procedures to include diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine imaging, such as positron emission tomography. While the statute allows the Secretary to specify additional types of diagnostic imaging services that may require accreditation, it expressly excludes x-ray, ultrasound, and fluoroscopy procedures, as well as diagnostic and screening mammography, from the accreditation requirement.
Accreditation for ADI services is granted to suppliers of the images themselves and not to the physicians interpreting the images, and suppliers must be accredited for each ADI modality for which they intend to bill. In its implementing regulation, the Centers for Medicare and Medicaid Services (CMS) describes in detail some of the basic areas that must be reviewed for accreditation, including personnel qualifications for non-physician medical staff, medical directors, and supervising physicians, image quality, equipment performance, safety standards for staff and patients, and quality assurance and quality control. See 42 C.F.R. Section 414.68.
Accrediting Organizations Approved
To date, CMS has approved three national accrediting organizations, the American College of Radiology, the Intersocietal Accreditation Commission, and the Joint Commission, to grant accreditation to suppliers of ADI services. The specific quality standards, accreditation cycle, accreditation process and prices differ among these organizations, so suppliers are advised to contact each of the three designated organizations to determine which meets their specific business model and philosophy for patient care.
Existing suppliers who become accredited on or before January 1, 2012 need not submit any paperwork to CMS or its contractors to notify the agency of their accreditation status. The designated accreditation organizations are responsible for transmitting the findings of all accreditation decisions, including identifying information, the accreditation effective date, and the modalities that are included in the accreditation, to CMS or its contractor when those decisions become final.
Going forward, CMS expects to revise its 855 enrollment applications to allow suppliers enrolling in Medicare for the first time to provide their accreditation information directly on those applications.
Suppliers who receive accreditation after January 1, 2012 will only be eligible to receive Medicare reimbursement for ADI services as of the effective date of their accreditation. Thus, to avoid any gaps in reimbursement, suppliers who are already accredited by a designated accrediting organization should ensure that any required renewal information is timely submitted so that their accreditation continues to be effective as of January 1, 2012. Those suppliers that are not yet accredited should begin the accreditation process as soon as possible, if they have not done so already. Though processing times vary depending on the complexity of the supplier organization, the accreditation process is currently estimated to take approximately three to five months upon receipt of a complete application.
For additional information, please contact Stacie Neroni or Nina Adatia in Los Angeles at 310.551.8111; Kitty Juniper in in San Diego at 619.744.7300 or Robert Roth in Washington, D.C. at 202.587.2590.
HLB RANKS IN TOP TIER OF LATEST CHAMBERS REVIEW OF LEADING HEALTH LAW FIRMS
Hooper, Lundy & Bookman, PC, has once again been named one of the top three health care law firms in California, according to the latest edition of Chambers USA. The directory is published by the prestigious Chambers & Partners, which produces law firm directories of top-rated law firms throughout the United States and Europe, ranking law firms primarily based on outside interviews with General Counsel, high-profile entrepreneurs and other significant purchasers of legal services.
In addition to the firm ranking, nine HLB attorneys were recognized as top performers in California, more than any other Chambers top-ranked firm. Three California attorneys – Lloyd Bookman, Stephen Lipton and Patric Hooper — were recognized as top performers in the country. In addition, Robert Roth was recognized as a top performer in Washington, D.C.
Following is the text of the firm’s profile, reprinted with permission of Chambers & Partners, USA. We thank all of our clients and friends who contributed to the Chambers review.
This healthcare boutique receives widespread praise for its uniformly excellent lawyers. It serves a range of healthcare providers and suppliers, including hospitals, pharmacies and long-term care facilities. Transactional work, litigation and regulatory issues are all handled by the group, whose Medicare and Medicaid reimbursement expertise is particularly applauded. In addition to its strong California presence with offices in Los Angeles, San Diego and San Francisco, the firm opened a Washington, DC office in 2010. A recent spate of hires from Davis Wright Tremaine has further strengthened the outfit.
Sources say: “The lawyers have the full scope of services and are totally dedicated to healthcare – their breadth and depth makes it so easy for us to operate.”
Robert Lundy is widely viewed as “one of the most respected healthcare lawyers in the country.” He continues to represent healthcare industry clients in various transactions including joint ventures, financings, M&A and licensing and certification matters.
Lloyd Bookman is a “first-class healthcare attorney” who is particularly noted for his expertise on reimbursement issues. Lately, he has worked extensively to ensure that clients have programs in place to fully comply with recent changes in legislation.
For over 30 years, Patric Hooper has specialized in litigation against the federal and state governments. Clients applaud his “practical approach.”
Bradley Tully “is superb at regulatory work and very quick at getting to the bottom of every issue.” In addition to his noted Medicare and Medicaid, fraud and abuse and antikickback expertise, he also represents providers in litigation involving regulatory compliance issues.
John Hellow chairs the firm’s regulatory practice group. Recently, his work has focused on defending providers in Medicare False Claims Act disputes involving cost reporting and antikickback-related issues. Clients say: “He is dependable and always makes us feel comfortable and pleased with the results.”
Charles Oppenheim has served as an expert on antikickback and Stark law issues in arbitration and litigation, in both civil and criminal proceedings.
Steven Lipton is a “go-to expert” on state regulatory matters including Stark and antikickback laws. Widely viewed as the “king of Emergency Medical Treatment and Active Labor Act matters,” he is
also praised as “timely, responsive and very easy to deal with.”
Clark Stanton is “a very responsive attorney with fabulous drafting skills.” His practice is focused on medical staff and health information privacy issues.
Paul Smith impresses clients with his ability to “integrate business needs along with the law,” and his skill at “taking very complex issues and breaking them down.”
Legal 500 Awards — HLB was recently named as one of the top 500 law firms the country by the Legal 500 United States Directory. In developing the directory, researchers interview CEOs, CFOs and General Counsel with a focus on the national capabilities of law firms.
Super Lawyers — Super Lawyers has recognized the following attorneys as 2011 Super Lawyers, based on peer recognition and professional achievement:
Southern California: Patric Hooper, Robert Lundy, Lloyd Bookman, Bradley Tully, John Hellow, Laurence Getzoff, David Henninger, Charles Oppenheim, Daron Tooch, Linda Kollar and Mark Hardiman.
San Francisco: Mark Reagan, Craig Cannizzo, Steven Lipton, Clark Stanton, Harry Shulman, and Paul Smith.
San Diego: Cary Miller
Rising Stars — HLB Attorneys David Hatch, Hope Levy-Biehl, Karl Schmitz and Devin Senelick have been recognized in the official Super Lawyers Rising Stars Edition for 2011, recognizing Southern California Rising Stars. Felicia Sze has received Rising Star recognition in Northern California.
Litigation Counsel of America — HLB Attorney Linda Kollar received a Spotlight feature in the June/July 2011 issue of LCA’s Litigation Commentary & Review.
HLB Attorney Gregory Daniels recently presented a webinar on eDiscovery and EHRs for Progressive Health.
||Quality Care Health Foundation Institute Summer Conference — San Diego.
Mark Johnson presents Contracting Issues
|August||3||Quality Care Health Foundation D.O.N. Intensive — Riverside
Mark Johnson presents cting Issues
Robert Roth participates in Medicare and Medicaid Repayments and Disclosures.
|September||11||HFMA California Chapters Annual Fall Conference — Long Beach
Daron Tooch presents ERISA: Maximizing Recovery from Self-Funded Plans
|15||Baker Healthcare Consulting Conference on Health Reform –
Charles Oppenheim presents ACOs — The Big Problem
|October||20||G2 Intelligence 29th Annual National Lab Institute –
Patric Hooper co-presents and participates on a panel titledWhat Should Keep You Up at Night: Lowest Lab Pricing May Be Closer Than You Think