Health Care Reform Requires Immediate and Longer Lead Time Changes Regarding CT, MRI and PET Scans

As we continue to review the recently enacted Patient Protection and Affordable Care Act, what is immediately striking is the broad range of regulatory requirements that will impact health care providers. Some of these requirements will not go into effect for a year or more. However, one requirement that became effective immediately upon the President signing the bill relates to in-office referrals for CT, MRI or PET scans. The Act requires a physician who refers an individual for CT, MRI or PET (which is being provided under the in-office ancillary services exception to the Stark Law) to “inform the individual in writing at the time of the referral that the individual may obtain the services for which the individual is being referred from a person other than” the referring physician or medical practice. In addition, any medical practice providing these diagnostic imaging services must “provide [their patient] with a written list of suppliers (as defined in section 1861(d)) who furnish such services in the area in which such individual resides.”

Again, this requirement is now in effect. Be aware that another recent change regarding CT, MRI and PET will soon impact health care providers. As required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), by Jan. 1, 2012, all suppliers of the technical component of advanced diagnostic imaging procedures must be accredited by an accreditation organization designated by the Secretary of Health and Human Services. MIPPA specifically defines advanced diagnostic imaging procedures as including diagnostic CT, MRI and PET scans.

The accreditation requirement applies to physicians, non-physician practitioners, and physician and non-physician organizations that are paid for providing the technical component of advanced imaging services under the Medicare Physician Fee Schedule. The accreditation requirement will apply only to the suppliers furnishing the imaging services, and not to the physician’s interpretation of the images.

CMS has designated three national accreditation organizations – the American College of Radiology (ACR), the Intersocietal Accreditation Commission (IAC), and The Joint Commission (TJC) - to accredit suppliers furnishing the technical component of advanced diagnostic imaging procedures.

CMS has promised to issue further guidance to suppliers about meeting the accreditation requirements. CMS plans to undertake a provider education outreach program to ensure that all affected suppliers understand the requirements and are able to comply with them prior to the Jan. 1, 2012 accreditation deadline.