Over the past year, many payers and utilization management companies have been looking at accreditation and certification. Large payers, such as United Healthcare, Aetna, and Blue Shield (and soon Blue Cross), require the outpatient facility and its equipment to meet the American College of Radiology requirements at the risk of losing their contracts. These requirements can be demanding, as seen in the Blue Shield list for MRI or CT, according to Guidelines for Providers Performing Imaging Procedures: Blue Shield of California.
Over the past year, many payers and utilization management companies have been looking at accreditation and certification. Large payers, such as United Healthcare, Aetna, and Blue Shield (and soon Blue Cross), require the outpatient facility and its equipment to meet the American College of Radiology requirements at the risk of losing their contracts. These requirements can be demanding, as seen in the Blue Shield list for MRI or CT, according to Guidelines for Providers Performing Imaging Procedures: Blue Shield of California. As the outpatient industry gets ready to meet these standards, vendors should know what the centers are up against. Reeling from recent Deficit Reduction Act cuts and other proposed cuts in reimbursement by Medicare, many centers are scrambling to simply sustain a viable business. Although many vendors say they will help with the accreditation process, too often their service departments give it low priority.
Previously, this approach worked when accreditation was nice to have but not mandatory. Vendors can help out in many ways and offer a value-add to current and future customers.
Quality self-referrals and utilization are moving from the hands of lobbyists to the payers. By familiarizing themselves with payer credentialing requirements and the ACR process, vendors can add great value to their sales approaches. They can win a sale or service contract from a competitor and help their customers during these challenging times. In short, everyone comes out a winner.
Steven R. Renard is a diagnostic imaging and radiology industry consultant with nearly 15 years of related experience, primarily in imaging center operations.
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