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August 2014
Enrollment for BCBSM’s new freestanding radiology center provider type begins Oct. 1
What is a freestanding radiology center?
A freestanding radiology center is a fixed-location or mobile facility that provides non-emergency diagnostic imaging services to ambulatory patients.
FRCs may include both nonhospital and hospital-owned facilities. An FRC doesn’t include doctor offices with imaging services if their primary focus is the management and treatment of their own patients’ conditions.
Mobile facilities are imaging units capable of operating remotely at two or more sites. The sites are authorized by the Michigan Department of Community Health under a contractual agreement. The mobile facilities must visit the sites on a regularly scheduled basis with the imaging technology typically not separate or unattached from the travel vehicle. Portable X-ray suppliers would not qualify as a mobile FRC.
Blue Cross Blue Shield of Michigan is establishing a freestanding radiology center provider type to recognize and reimburse freestanding providers of diagnostic imaging services.
Eligible hospital and nonhospital-owned FRCs can enroll in the BCBSM Traditional network, beginning Oct. 1, 2014. Enrollment materials will be available on bcbsm.com in late September.
The FRC provider type will go into effect on Jan. 1, 2015.
All participating FRCs will be considered in-network for PPO members, and out-of-network sanctions will be waived.
Establishing the freestanding radiology center provider type will make it easier for BCBSM members to find providers of diagnostic imaging services within BCBSM’s Traditional network. It will also help us enhance the provider- and service-related cost transparency information available to our members.
By designating FRCs as a unique provider type, it will be easier for members to locate these providers. FRCs will be included in provider directories on bcbsm.com and on the Blue Cross® and Blue Shield® Association website. BCBSM will also be able to list cost information, by procedure, for each of the freestanding radiology centers in the provider directories.
Billing information
Freestanding radiology centers will be reimbursed for all diagnostic imaging services that are covered benefits. The covered benefits must be in compliance with Certificate of Need rules and within the approved scope of practice of the rendering provider.
Diagnostic imaging services performed in freestanding radiology centers will be subject to the current Radiology Management program pre-authorization and privileging requirements.
It’s also important to know that:
- Freestanding radiology centers must bill all services on a CMS-1500 professional claim form or the electronic equivalent. Freestanding radiology centers will be allowed to bill for the professional or technical component or the full fee, depending on the provided service.
- Applicants who are currently enrolled as physician group practices may qualify as freestanding radiology centers. In order to be designated as a FRC, these providers will be asked to terminate their current provider identification number and enroll under a new PIN. The existing National Provider Identifier will be mapped to the new FRC record.
Look for more information about our freestanding radiology center provider type in future Record articles. | 