Highmark Blue Cross Blue Shield (Western PA)
Unveils Program To Help Ensure High-Quality Imaging Services
from
the October 2004 issue
In
a July 13, 2004 letter to providers, Highmark Blue Cross
Blue Shield announced that, effective January 1, 2005, all providers
of diagnostic imaging services performed outside of a hospital
setting will be required to adhere to new privileging guidelines.
As detailed below, guidelines now exist related to each of the
accrediting bodies within the Intersocietal Accreditation Commission:
the ICAVL, the ICAEL and the ICANL.
According
to Augusta L. Kairys, Vice President of Provider Relations for
Highmark Blue Cross Blue Shield, "These guidelines have
been developed to promote reasonable and consistent quality
and safety standards for the provision of imaging services."
The new privileging guidelines apply to most Highmark health
plans in Western Pennsylvania (29 counties). Highmark plans
to implement the program in Central Pennsylvania (21 counties)
at a later date. Highmark has signed an agreement with National
Imaging Associates, Inc., a national radiology management company,
to help implement the program.
GUIDELINES
SPECIFIC TO PERIPHERAL VASCULAR (PV) ULTRASOUND
- PV
Ultrasound must be performed by physicians credentialed by
Highmark and/or Keystone Health Plan West in diagnostic radiology,
vascular surgery, cardiology or neurology.
- PV
Ultrasound providers must employ a sonographer certified by
the American Registry of Diagnostic Medical Sonographers (ARDMS)
or ARRT.
- PV
Ultrasound systems must have Color Flow Doppler capability.
- PV
Ultrasound providers must achieve accreditation by ICAVL (Intersocietal
Commission for the Accreditation of Vascular Laboratories)
or the ACR (American College of Radiology) within two years
of Provisional acceptance in the Privileging Program.
[NOTE: Practice must submit evidence of application for accreditation
within 3 months of receipt of the letter indicating Provisional
acceptance.]
GUIDELINES
SPECIFIC TO ECHOCARDIOGRAPHY
- Echocardiography
must be performed by physicians credentialed by Highmark and/or
Keystone Health Plan West in diagnostic radiology or cardiology.
- Echocardiography
systems must have Color Flow Doppler capability.
- Echocardiography
practices must achieve accreditation by ICAEL (Intersocietal
Commission for the Accreditation of Echocardiography Laboratories)
within two years of Provisional acceptance in the Privileging
Program. [NOTE: Practice must submit evidence of application
for accreditation within 3 months of receipt of the letter
indicating Provisional acceptance.]
GUIDELINES
SPECIFIC TO NUCLEAR CARDIOLOGY
- Nuclear
cardiology practices must employ at least one physician who
is Highmark credentialed in diagnostic radiology, nuclear
medicine or has received certification by the Certification
Board of Nuclear Cardiology (CBNC).
- Nuclear
cardiology practices that do not meet the above criteria will
be considered for participation upon submitting evidence that
at least one physician has satisfied the Level II training
in Nuclear Cardiology as recommended in the American College
of Cardiology / American Society of Nuclear Cardiology, Core
Cardiology Training Symposium (COCATS) Training Guidelines.
- Nuclear
cardiology imaging systems must have the capability of assessing
both myocardial perfusion and contractile function (ejection
fraction and regional wall motion).
- Cardiac
stress tests must be performed under the direct supervision
of a licensed physician who has a current Advanced Cardiac
Life Support (ACLS) certification.
- 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 address
and physician name(s) must be the same as those listed on
the Privileging Application completed by the practice.
- Nuclear
cardiology practices must use a technologist who is 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 Medicine Laboratories)
or the ACR (American College of Radiology) within two years
of Provisional acceptance in the Privileging Program. [NOTE:
Practice must submit evidence of application for accreditation
within 3 months of receipt of the letter indicating Provisional
acceptance.]
The
Highmark Privileging Guidelines also include requirements for
Bone Densitometry; Obstetrical/Gynecological Ultrasound; Urological
Imaging; Mammography; Positron Emission Tomography (PET); CT,
MR and/or Fluoroscopy and Practices Specializing in Women's
Health.
Diagnostic
imaging providers with questions about any of the above guidelines
should contact the National Imaging Associates (NIA) Quality
Assessment Department at 888-972-9642 or their Highmark Provider
Relations representative.
Read
the Highmark Blue Cross Blue Shield press release. >>
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