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In
a July 13, 2004 letter to all providers, Highmark Blue Cross
Blue Shield announced that, effective January 1, 2005, all
providers of diagnostic imaging services performed outside 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 ICANL, the ICAEL and the ICAVL.
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 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 the Radioactive
Materials License that indicates the practice address and
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 [RT(N)], Certified Nuclear
Medicine Technologist or Nuclear Medicine Technology Certification
Board [CNMT], or licensed by the state in nuclear medicine
technology.
- Nuclear
cardiology practices must achieve accreditation by the 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.]
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