Anthem’s Medicare Advantage department recently published an Outreach and Education Bulletin regarding Outpatient Diagnostic Imaging. A copy of the full bulletin can be found using the link below.
Beginning November 1, 2015 Anthem Medicare Advantage will begin collecting information about contracted providers that provide a variety of diagnostic imaging services which will include ultrasound services. Each practice will need to register each and every location, physician and ultrasonographer with OptiNet administered by AIM Specialty Health.
The OptiNet registration will ask a variety of questions regarding the physician’s credentials including board certification and additional training and qualifications like RPVI or RPHS. They will likewise ask about your ultrasonographer’s training and credentials. OptiNet will also be asking about the equipment itself including the age of the machine.
After all of these questions are answered, you will be given a score. If the score is below 76 or you do not complete the survey, you will only be paid the professional component for your ultrasound services with a date of service on or after March 1, 2016. The score is based on conformance with industry-recognized standards including the American College of Radiology (ACR) and the Intersociety Accreditation Commission (IAC). As noted, this is only for Anthem’s Medicare Advantage right now. I would not be surprised if this is expanded to all of Anthem’s product lines as BCBS TX, BCBS LA and BCBS IL are already operating under a similar process.
You will need to complete this one time per practice location. Thereafter you will receive emails noting when an update is necessary due to credentials expiring and other similar issues. If you have staffing or equipment changes you will likewise need to update your information via OptiNet.
If you, your ultrasongrapher or your practice does not have strong credentials for performing ultrasound services, now is the time to start ensuring you have stronger conformance with ACR and IAC standards. Right now it is just Anthem and just their Medicare Advantage program. Before long, I see something like this expanding to other Medicare Advantage payer programs and to other Blues plans in general. You may want to plan accordingly.
https://www.anthem.com/shared/noapplication/f2/s2/t1/pw_e237957.pdf?refer=ahpprovider
No comments yet.