Consultant describes how MRI services can meet accreditation deadline

Bob Bell has advice for the scores of freestanding MRI services that suddenly faced a possible loss of privately insured business when United Healthcare announced that it would limit reimbursement to sites that are accredited or seeking accreditation on March 1, 2008.

United Healthcare's mandate extends to CT, CT angiography, MRA, PET, nuclear medicine/cardiology, and echocardiography. Facilities may be accredited through either the American College of Radiology or the Intersocietal Accreditation Commission. United Healthcare's requirements are described on its website.

Bell has been contracted as a consultant for than 1000 MRI systems over the past 20 years to make sure new installed scanners perform as promised by their manufacturers. He advises nonaccredited sites to apply early because the process can take up to six months.

It's best to designate someone in your organization as the go-to person regarding MRI accreditation, he said. This person should develop a timeline for critical events and then coordinate efforts to stay on it. He or she shouldn't be afraid to delegate responsibilities but must follow up to ensure each task's timely completion.

The purpose of the annual MRI performance testing is to independently review equipment and quality control procedures and identify areas that may need attention. Your MRI scientist or medical physicist should resolve questions about the technical aspects of accreditation and provide help with QC. Selecting someone with sufficient experience in MRI testing and your type of equipment is vital.

It is certainly a benefit to have technologists involved with the process of reviewing QC methods and requirements, but testing should not be dependent on them. If your physics expert relies upon your service provider to conduct the testing, independence can be called into question.

The ACR has made first-time application easier by providing online processing. The intersociety programs are described on its website.

The ACR has indicated that it may reject test reports that do not address the 16 required areas outlined in the physicist's section of the ACR MRI QC Manual. This can delay accreditation until the report is amended. Ask questions and get assurances that your physics expert will help your efforts.

Most sites fail because they submit faulty information, not because their equipment or techniques are faulty. ACR requires in-plane and through-plane resolution in clinical exams to meet or exceed its guidelines. It has provided an excellent phantom scanning guide that shows what the required test scans should look like and how they will be evaluated.

By checking your input, you can markedly improve your chances. Bell said.

Most sites qualify for ACR accreditation without complications the first time they apply, according to Bell. Of those that do encounter a problem, only a handful ultimately are not able to be accredited.

Bell advises applicants who receive a notice of failure to read it carefully to understand the rationale for rejection. Most failures involve either a technical or a clinical problem. If the problem is clinical, Bell suggests involving the clinical director to review and respond to the notice.

If the notice of failure stems from scan technique, applicants can appeal and explain the rationale for their technique. The facilities physics expert should be called in to address technical failures to qualify for accreditation, Bell said. In many cases, appeals are granted and accreditation proceeds.

As of Aug. 1, the ACR had accredited 3779 MRI facilities. Another 719 applications are under review. Because many locations have several magnets, more 5000 than MRI units have been accredited by the ACR program.

Bell can be contacted by e-mail at bell3660@sbcglobal.net.

For more information from the Diagnostic Imaging archives:

ACR introduces modular approach for its MRI accreditation program

Cardiac CT accreditation gets a break

College, society drop out of surgeon-sponsored breast ultrasound accreditation program

ACR launches cardiac MRI accreditation program