08/17/2011
Radiology Quality Initiative (RQI) requirement extends to select group and Individual products effective Sept. 1
Advanced imaging is among the fastest-growing clinical services in health care, increasing at an annual rate of 10% to 20% a year nationally. While the rapidly improving technology and clinical application of these services are the leading drivers of growth, some portion of this growth is due to procedures that are clinically unnecessary.
Given the potentially negative clinical implications of unnecessary testing, such as exposure to high doses of ionizing radiation, as well as the high costs of these tests, we implemented the Radiology Quality Initiative (RQI) in June 2009. Under RQI, ordering or referring physicians are required to contact our URAC-accredited vendor partner, American Imaging Management (AIM), to obtain an order ID number before scheduling an elective outpatient advanced diagnostic imaging procedure.
In March 2011 we expanded the RQI program to require that an order number be obtained for Regence MedAdvantage members prior to specific imaging procedures being performed. Effective Sept. 1, 2011, we're expanding this requirement to all members enrolled in the following group and Individual products:
- Uniform Medical Plan
- Regence HSA Healthplan 2.0SM
- Regence Innova®, Regence Engage® and Regence ActivateSM
- Regence EvolveSM
RQI requires that providers contact AIM to obtain an order ID number before scheduling an elective outpatient advanced diagnostic imaging procedure. When an order number isn't obtained, the procedure is denied as a provider responsibility. Imaging facilities are also encouraged to confirm that an order ID number has been obtained prior to performing the select procedures in an outpatient elective setting. The procedures listed below will be denied as provider responsibility if an order number isn't obtained from AIM prior to the procedure being performed on an outpatient basis:
- Nuclear cardiology
- Positron emission tomography (PET)
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
- Computerized tomography (CT)
- Computerized tomography angiography (CTA)
This policy applies to procedures performed in a physician's office, free-standing imaging center or outpatient hospital setting. Imaging procedures performed in conjunction with emergency room services, inpatient hospitalization, outpatient surgery or 23-hour observations are excluded from this requirement. As our larger employer groups move to our new claims system in 2012, the expanded program will also apply to those groups. Regence Bridge Medigap products and Healthy Options are excluded from this program requirement.
Ensuring that advanced diagnostic imaging services are based on widely accepted clinical judgment fits with our commitment to delivering a high quality and sustainable health care system for our members.
For more information on the RQI program, please contact your Regence Sales executive.
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