April 2004 | Vol. 22/No. 4

New Medicare Policies for New York and New Jersey

The Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL) reports that Empire Medicare, handling Medicare policies of New York and New Jersey, has recently published their final policy, which will go into effect April 4, 2004.

The policy reads as follows:

TRAINING REQUIREMENTS:

While it is not the Carrier's intention or jurisdiction to credential providers, Medicare does expect a satisfactory level of competence from providers who submit claims for services rendered. It is well known that substandard studies often lead to preventable repetition of studies and overutilization of services.

The acceptable levels of competence are outlined as follows:

For the technical portion, an acceptable level of competence is fulfilled when the image acquisition is obtained under any one of the following conditions:

a. The service is performed by a physician; or

b. The service is performed by a technician who is credentialed as either a Registered Diagnostic Cardiac Sonographer (RDCS) through the American Registry of Diagnostic Medical Sonographers or as a Registered Cardiac Sonographer (RCS) through the Cardiovascular Credentialing International; or

c. The service is performed at a laboratory (e.g., office, IDTF), credentialed by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL).

For the professional portion, an acceptable level of competence is fulfilled when the interpretation is performed by a physician meeting any one of the following requirements:

a. The physician is board certified in Cardiovascular Diseases; or

b. The physician has Level II training in transthoracic echocardiography, as defined by the American College of Cardiology/American Heart Association/American College of Physicians Task Force on Clinical Competence in Echocardiography, or the equivalent of Level II training as set forth in that document; or

c. The physician provides the interpretation in conjunction with a study that is performed at a laboratory that is accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories and that is subject to such laboratory's quality assurance policies and procedures; or

d. The physician has staff privileges to interpret echocardiograms at a hospital that participates in the Medicare program.

The submission of claims for echocardiography will be considered an attestation that both the technical and professional components of the service were provided within the context of the above stated credentials. However, a grace period of two years will be allowed for providers to acquire the necessary training.

This policy can be viewed in its entirety on the Empire Medicare website.