Mandatory Accreditation?Is the accreditation of MRI facilities mandatory?
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In the United States accreditation for MRI and other imaging procedures such as CT, Nuclear Medicine, and PET derive from provisions of the 2008 Medicare Improvements for Patients and Providers Act (MIPPA), which was reauthorized by Congress in 2018.
Specifically, accreditation is required to receive payment for MRI exams billed under Part B of the Medicare Physician Fee Schedule. Currently this regulation applies to private outpatient facilities only, not to hospitals.
Following the lead of Medicare, many insurance companies, Radiology Benefits Management (RBM) companies, and state Medicaid programs have made reimbursement or a portion of reimbursement for MRI contingent on a facility’s accreditation, even for non-Medicare patients.
IN BRIEF: Accreditation is only mandatory if you wish to be paid!
Specifically, accreditation is required to receive payment for MRI exams billed under Part B of the Medicare Physician Fee Schedule. Currently this regulation applies to private outpatient facilities only, not to hospitals.
Following the lead of Medicare, many insurance companies, Radiology Benefits Management (RBM) companies, and state Medicaid programs have made reimbursement or a portion of reimbursement for MRI contingent on a facility’s accreditation, even for non-Medicare patients.
IN BRIEF: Accreditation is only mandatory if you wish to be paid!
References
Medicare Improvements for Patients and Providers Act of 2008 (pdf). Public Law 110-275. The provisions relating to imaging can be found in Section 135 beginning on page 39 of the pdf. An html version of the document can be accessed by clicking here.
Medicare Improvements for Patients and Providers Act of 2008 (pdf). Public Law 110-275. The provisions relating to imaging can be found in Section 135 beginning on page 39 of the pdf. An html version of the document can be accessed by clicking here.
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