RadSite Benefits for Payers
RadSite™ Sets Quality Standards for Advanced Diagnostic Imaging
RadSite works with a wide range of stakeholders to recognize advanced diagnostic imaging providers that demonstrate a commitment to quality and safety, creating networks that deliver an overall higher level of services to patients. The accreditation organization extends the reach of its quality-based mission by working with private payer organizations and radiology benefit management companies (RBMs).
In addition, RadSite is recognized by the Centers for Medicare and Medicaid Services (CMS) as an official accreditation organization under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 for advanced diagnostic imaging (ADI). RadSite’s programs help assess, track and report imaging trends in an effort to enhance imaging procedures and outcomes.
RadSite’s MAP accreditation experience offers insurers an excellent contract management tool to focus on outcomes, costs and a quality improvement framework that brings value to your organization’s management of imaging services to your covered lives.
Improved Quality and Efficiency through Accreditation
Some payers choose to no longer reimburse claims from non-accredited ADI providers or remove them from their network. The difference in claims activity between the accredited provider community and the non-accredited providers shows that the high quality providers bill less for diagnostic imaging. Some providers even stop billing when a quality program is introduced. Another savings assumption is that quality imaging saves money by creating the shortest path to an accurate diagnosis and a successful treatment.
A well-credentialed imaging network leads to more appropriate utilization of imaging procedures and greater cost savings overall. Because mandatory accreditation creates a nationally recognized network of advanced diagnostic imaging providers, both payers and RBMs can generate savings from the improved use of imaging exams.
RadSite’s MIPPA Accreditation Program
RadSite offers a comprehensive, affordable, quality-based accreditation program that evaluates providers on the basis of established industry standards and best-practices through its MIPPA Accreditation Program (MAP). RadSite recognition of a facility demonstrates to both patients, payers, regulators and others that a provider is a clear leader in imaging quality and patient safety.
Imaging providers that seek to bill both CMS and private third-party payers can utilize RadSite to demonstrate their compliance with federal guidelines and industry best-practices. RadSite’s MAP Standards include a review of personnel, policies and procedures, as well as sample clinical images and phantom studies. The user-friendly program allows providers to apply for accreditation of their CT, MRI, PET and SPECT imaging systems with a single application.
For example, the MAP Standards include a technical component evaluation that assesses the performance of each imaging system and examines the quality of the images that each imaging system produces. RadSite additionally requires applicants to submit medical physicist reports and specific case studies for each imaging system to ensure quality.
Public Sector Recognition
Formally recognized by CMS, RadSite is approved to accredit suppliers seeking to furnish the technical component (TC) of advanced diagnostic imaging services under the Medicare Program pursuant to Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for the accreditation of CT, MRI and PET and SPECT.
In the Federal Register notice, Marilyn Tavenner, the CMS Administrator, states:
We have completed our review and believe that RadSite™ has provided us with demonstrated evidence of their qualifications and ability to accredit the categories of advanced diagnostic imaging services to include computerized tomography, nuclear medicine, positron emission tomography, and magnetic resonance imaging as defined in sections 1834(e0(1)(B) and 1848(b)(4)(B) of the (Social Security Act). Therefore, this notice announces our approval of RadSite™ to accredit supplier furnishing the TC of all advanced imaging modalities (that is, computerized, nuclear medicine, positron emission tomography, and magnetic resonance imaging) on or after September 27, 2013.
- Federal Register, Vol. 78, No. 188, Friday September 27, 2013.
Private Sector Recognitions
In addition, many private payers recognize RadSite’s MIPPA Accreditation Program (MAP), including insurers such as Aetna, Empire Blue Cross Blue Shield of NY, Spreemo, OneCall, Cigna, United Health Care Group (UHC) and Humana. Furthermore, most of the radiology benefit management (RBM) organizations recognize RadSite’s MAP Program including AIM Specialty Health, HealthHelp and MedSolutions. RadSite continues its effort to become recognized nationally by third party payers and merging RBMs.
These recognitions showcase the value that a MAP-accredited network can generate to promote value-based purchasing. Payers can create “smart” networks by recognizing, and even requiring, all of their imaging providers to be MAP accredited in a fashion similar to CMS. The result is simply to create a network with higher quality and more appropriate utilization of imaging services, which in turn promote positive clinical and financial outcomes for plans, imaging providers and patients.
RadSite also can work with public and private payers to add additional standards to provide an even higher degree of fidelity to the accreditation process depending on what additional areas the payer would like covered.
Promoting Quality Imaging
RadSite works with health plans to work with their participating imaging providers to help raise imaging standards through MAP by:
- Meaningful Standards.
- Relying on a Standards Committee representing a broad array of stakeholders and imaging experts
- Drafting standards over a two year period which include key outcomes measures by a technical evaluation of imaging case studies
- Updating standards when necessary to maintain the most current quality and performance benchmarks
- Meaningful Accreditation Process. Deploying traditional best-in-class accreditation auditing techniques, which include:
- Collecting information mostly through an online portal, including an efficient way to upload image case studies.
- Scoring through a pass/fail system the streamlines the process
- Assessing all accreditation applications through an impartial Accreditation Committee
- Utilizing a 60-day corrective action period, when appropriate, to remedy any deficiencies.
- Relying on an educational approach to promote quality improvement during the accreditation process and help imaging facilities remediate any shortcomings.
- Providing constructive feedback through consultative on-site visits and lists of suggested opportunities for improvement that can help all applicants take gradual steps to improving their quality even further.
- Reasonably Priced.
- Utilizing very fair pricing to keep the costs of accreditation affordable
- Avoiding any hidden or extra charges along the way.
- Quality seal. Accrediting only those applicants that demonstrate high quality performance meeting or exceeding our standards. If an imaging provider cannot meet RadSite’s MAP standards, it ultimately will fail and not carry RadSite’s accreditation seal.
Diagnostic imaging centers that go through the MAP program to demonstrate their compliance with quality metrics such as appropriate staff training, safety policies and equipment maintenance, perform higher quality and more appropriate examinations on their patients. In health plan networks where provider accreditation is mandatory, imaging facilities falling below industry standards are not reimbursed. This leads members to obtain these services from higher quality providers and safeguards the membership from potential harm.
Advanced Diagnostic Systems Covered by RadSite
RadSite covers the following hi-tech imaging modalities:
- SPECT (Nuclear Medicine)
Because of the cost associated with advanced diagnostic imaging and the potential exposure to ionizing radiation for most procedures, RadSite initially has focused advanced diagnostic systems. In the future, RadSite also will be launching several accreditation programs covering different types of imaging systems and services. Stay tuned!