Appeals of ACR Accreditation Decisions
What are my options if my facility does not receive accreditation?
The stakes for ACR members and their practices have risen dramatically, particularly in relation to accreditation. As of January 1, 2012, CMS began requiring accreditation from designated organizations such as the ACR for suppliers that furnish the technical component of advanced diagnostic imaging services in a non-hospital setting.
Any supplier that fails to obtain accreditation will not receive reimbursement from CMS for those services.
Consequently, obtaining and keeping accreditation signifies high quality and will help practices to remain in good financial standing with Medicare. This column will outline what a facility can and must do if it receives an adverse decision from the ACR and initially cannot obtain or renew its accreditation.
Diagnostic Imaging Accreditation
Q:My facility did not pass diagnostic imaging accreditation. May we appeal the decision? If so, what's involved?
A:Yes. Facilities that receive a deficiency or a failure may appeal the determination in writing within 15 days of the final report. You must send the original images for all of the submitted cases in the category that did not pass along with a letter describing your reason for appealing. Only images from the same patient study or phantom testing originally submitted will be considered during the appeal evaluation. These will be forwarded to an arbitrator (a reviewer who did not participate in the initial review) with a copy of the previous reviews and the appeal letter written by the facility. No other images will be sent to the reviewer for consideration in the evaluation. The arbitrator's determination will be final.
Q:We recently appealed an adverse accreditation decision. When should we receive the results of the appeal?
A:You should receive the appeal results within 30 to 45 days of the date all required appeal materials were received by the ACR.
Q:We did not pass accreditation because our technologists selected and submitted the wrong images. May we appeal the decision and submit new cases?
A:Although you may appeal the decision, you may not submit new cases. During accreditation review, the ACR reviewers assume that the submitted cases were reviewed by the modality's supervising physician (as specified in the Testing Instructions) and are examples of your best work. Consequently, during an appeal, you may only submit the original patient or phantom testing images.
Q:We did not pass accreditation because our technologist did not submit all required images and provided insufficient information with the images that were submitted. May we appeal the decision and submit the rest of the required information?
A:You may appeal the decision by submitting the original patient study or phantom testing along with the missing information, as long as all of the images and data are from the original patient or phantom testing. If the submission was electronic, an opportunity to upload additional appeal information and images is provided in the online option form. Please call the Diagnostic Modality Accreditation Information Line at (800) 770-0145 for further guidance on your specific situation.
Q:My facility failed mammography accreditation. May we appeal the decision? If so, what's involved?
A:Yes. Facilities that receive a deficiency or a failure may appeal the determination in writing within 30 days of the final report. The original films or data must be submitted with a letter describing your reason for appealing. Only those films reviewed for the original determination will be considered during the appeal evaluation. Both fatty and dense cases must be submitted for clinical appeals in order to allow the reviewer to assess the overall clinical performance of the facility. Films will be forwarded to an arbitrator (a reviewer who did not participate in the initial review) with a copy of the previous reviews and the appeal letter written by the facility. No other films or data will be sent to the reviewer for consideration in the evaluation. The arbitrator's determination will be final.
If a unit is denied accreditation after an appeal of a failure (second deficiency), the facility may appeal directly to the FDA. However, such an appeal will stop the ACR application process until the FDA renders a decision.
Further, the facility making the appeal may not perform mammography during the FDA appeal process.
ACR accreditation requirements do not represent an applicable legal standard of care. While they may lead to best clinical practices for many facilities in a particular region, the ACR does not intend that each facility, its radiologists, and staff be held legally accountable to adhere to them. The CMS mandate should motivate members and their health care team to seek and maintain accreditation. However, it's not just the government that cares. Patients increasingly recognize the value of accreditation and ask about a facility's status. Their concern provides added incentive for you to understand your rights and obligations in the accreditation process.
By Bill Shields, JD, LLM, CAE, and Tom Hoffman, JD, CAE