Anthem Changes in 2016: How They Will Affect Your Practice

Anthem, the company providing family health plans to more than 38 million people, is making a big change in 2016—and it will affect your practice.

For years, the insurance company has required every provider performing ultrasound, CT, CTA, MRI, MRA, MRS, PET, cardiac echocardiography or nuclear cardiology imaging to be accredited by at least one of four organizations for every piece of equipment used in the clinic.

• Intersocietal Accreditation Commission (IAC), which provides accreditation programs for a range of specialties including vascular testing, MRI, and vein treatment and management;
• American College of Radiology, which provides accreditation programs in CT, MRI, PET and nuclear medicine;
• American Institute of Ultrasound in Medicine (AIUM), which offers accreditation in ultrasound equipment and practice; and
• American Society of Breast Surgeons, which offers accreditation focused on ultrasound related to breast health.

If you’re currently providing imaging services, you must be accredited—otherwise payment might be denied. If you’re just beginning to provide imaging services, you have one year to secure accreditation from the organizations listed above for the services you’ll offer. You’ll want to obtain accreditation, because once 12 months have passed you won’t be able to bill any patients—and you won’t be reimbursed by Anthem—without it.

Achieving IAC accreditation (as well as other types) can be a long and complicated process, and it’s not something you’ll accomplish without a strategy.

In addition to requiring all providers to have accreditation for every piece of equipment used, Anthem is now requiring proof.

If Anthem sends you a written request for accreditation confirmation, you’ll have 30 days to respond with proof. That’s not enough time to apply for and achieve accreditation from any of the four organizations listed above. And that’s why many providers are turning to outside partners to bring equipment to their clinics and provide accredited, professional imaging services.

Partnering with an accredited diagnostic imaging service provider is simple, patient-focused and profitable. It also doesn’t require you to invest a lot of time, money and energy into achieving accreditation for every piece of equipment you use. However, that doesn’t mean you won’t have to meet other requirements. For example, you’ll need to complete the company’s online registration by March 1, 2016 if you’re an Anthem Medicare provider. If you do not register, outpatient diagnostic services will be denied.

So get accredited, register and find a partner.