Q.  What is the AIUM?

A.  The American Institute of Ultrasound in Medicine is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of guidelines, and accreditation.

The AIUM first started accrediting ultrasound practices in 1996. In addition to offering accreditation in ultrasound in the practice of urology, the AIUM offers accreditation in the following ultrasound specialties:

• abdominal/general
• breast
• fetal echocardiography
• gynecologic
• musculoskeletal
• obstetric ultrasound
• thyroid ultrasound

Q.  How were the requirements for ultrasound accreditation in the practice of urology determined?

A.  The American Urological Association and the American Institute of Ultrasound in Medicine jointly developed and approved the guidelines for physician training and experience, continuing medical education requirements, and the guidelines for the performance of ultrasound examinations in the practice of urology.

Q.  If some of the physicians in a practice do not meet the training guidelines for the performance of ultrasound examinations how does this affect the practice?

A.  It does not affect the overall practice accreditation but that physician may not perform or bill for ultrasound procedures.

Q.  What is ultrasound practice accreditation?

A.  Summary:

• Ultrasound practice accreditation is a peer review process by which providers can demonstrate that they meet nationally recognized standards and guidelines.
• Unlike certification, ultrasound practice accreditation looks at all aspects of the ultrasound components of your practice, including:
  • Physician training and experience in performing and/or interpreting ultrasound examinations
  • Non-physician qualifications to perform ultrasound examinations
  • Ultrasound exam protocols
  • Ultrasound machine maintenance and calibration
  • Transducer cleaning and disinfection
  • Evaluation of actual case studies
• Also, unlike certification, all of the physicians in the practice who perform and/or interpret ultrasound exams are covered under a single application.
• A practice that performs ultrasound studies at several locations may cover all of the sites under a single application.

Q.  Do I have to be accredited?

A.  The AIUM accreditation is voluntary. Neither the AUA nor the AIUM require accreditation. However, some insurance carriers are beginning to require accreditation in order to receive reimbursement for ultrasounds performed in the office setting.

Q.  What are the benefits of urologic ultrasound accreditation?

A.  Third party payers that require accreditation in ultrasound as a condition for reimbursement recognize AIUM-accredited ultrasound practices as meeting their requirements. An accreditation of your urology practice will show that you believe in providing care of the utmost quality, in using equipment that is calibrated and monitored yearly to make sure images are clear, and affirms that the practice has a high level of concern for their patients.

Q.  Where can I get a copy of the Joint AUA/AIUM Practice Guideline for the Use of Ultrasound in the Urologic Practice?

A.  Access the Joint AUA/AIUM Practice Guideline.

There are also official statements on Training Guidelines for the Performance of Ultrasound Examinations in the Practice of Urology as well as Standards and Guidelines for the Accreditation of Ultrasound Practices. These two documents work together to explain the appropriate training criteria and required number of ultrasounds performed to meet AIUM's criteria. All three documents work together to determine if the urologist has met all the criteria for training and performance of ultrasound for urologic practice as well as the official guidelines for ultrasound of the kidney, ureter, bladder, prostate, penis and scrotum.

Q.  How does the AIUM determine the quality of the ultrasound exams performed by a practice?

A.  Summary:

• Practices are required to submit the images and reports from diagnostic ultrasound examinations in the areas most commonly scanned by the practice.
• A practice's principal site must submit 4 cases, and 1 additional case is required from every additional site.
• The cases are reviewed by two individual reviewers, and scored according to the Practice Guidelines for the Performance of Ultrasound Examinations in the Practice of Urology.

Q.  How much does it cost to apply for accreditation?

A.  The accreditation fee is determined by the number of specialties (renal, bladder, prostate, scrotal, and penile ultrasound are all covered under the single specialty of ultrasound in the practice of urology), the number of sites at which ultrasound exams are performed, and the number of ultrasound machines at each site. A practice with a single site and 1 or 2 ultrasound machines would pay $1,000. A practice with 2 sites, each with 5 machines, would pay $1800.

If and when the practice is granted accreditation, there is no additional fee until the practice applies for reaccreditation.

See Accreditation Fee Worksheet [pdf]

Q.  What are the steps to receive accreditation?

A.  Access the AIUM webpage with all the information needed to "Get Started."

This link will provide you specific instructions on what is required to obtain accreditation for your urology practice. This page includes links the online application, application checklist and other important information.

AIUM Ultrasound Practice Accreditation Step by Step Instructions PowerPoint.

Q.  How long does it take to become accredited?

A.  It may take up to 6 months from the time the complete application is received until a decision is rendered.

Q.  How long does accreditation last?

A.  Accreditation is granted for 3 years.

Q.  What should the practice do if there are changes before it is due to apply for reaccreditation?

A.  The practice should contact the AIUM Accreditation Department if it needs to add or delete personnel or sites or make other significant changes.

Q.  How do I contact the AIUM if I have questions on the accreditation process?

A.  The AIUM Accreditation Department can be reached at 301-498-4100, 800-638-5352 or accreditation@aium.org with any problems or questions regarding the accreditation process.

Q.  What role does AUA play in the accreditation process?

A.  The AUA provides educational opportunities that enable urologists to meet the training guidelines required for accreditation. The courses offered by the AUA include didactic and hands-on courses in urologic ultrasound with AMA PRA Category 1 Credits™ Level 2 certification. The AUA Hands-on Urologic Ultrasound Course is offered at locations throughout the country and at the AUA Annual Meeting. Information on the Hands-on Ultrasound Course is available through the AUA website.

The AUA collaborated with the AIUM to develop the criteria for the accreditation program specifically for urologic practices. The AUA does not require accreditation. Application and approval for accreditation are through the AIUM only.

Q.  What if I have already completed an AUA Hands-on Ultrasound Course?

A.  Successful completion of the AUA Hands-on Ultrasound Course since September 2007 counts towards the criteria for training in the accreditation process. The Training Guidelines state "Board certified in urology prior to July 1, 2009 and submit an attestation of experience including involvement with 100 diagnostic ultrasound examinations and training in urologic ultrasound which includes at least a minimum of 12 hours of AMA PRA Category I credits™ Level 2 course(s) verifying the individual has satisfactorily met all specified learning objectives for the Level 2 classification course(s). CME must be AUA or AIUM-approved courses and include both didactic and hands-on ultrasound." A copy of the Level II Certificate must accompany the accreditation application.

Q.  What is the difference between Level II and Level I certification?

A.  Level II certifies that the learner has met the objectives of the course. The objectives include a passing score on a didactic exam and successful completion of a hands-on module led by a trained instructor in urologic ultrasound. Level I certifies course attendance only.

Q.  How do I find a schedule of AUA Hands-on Urologic Ultrasound courses?

A.  Access a complete schedule of upcoming ultrasound courses.

Q.  Can I schedule a private Hands-on Ultrasound course for my practice or institution?

A.  Yes, you may request a private Hands-on Urologic Ultrasound Course by the AUA by completing a course inquiry form. You can also email education@AUAnet.org for more information.

Q.  One of the requirements for accreditation is the maintenance of competence in Genitourinary Ultrasound, which states "The physician should complete 10 hours of AMA PRA Category 1 Credits™ specific to genitourinary ultrasound every three years." Is there a listing of approved genitourinary ultrasound courses?

A.  Yes, there are many courses offered at the AUA Annual Meeting every year and other regional education courses available as well. In addition, there are videos and CDs available for CME credit through the AUA and AIUM. A listing of CME credit offerings is now available.

What the experts think:

Pat F. Fulgham, MD, FACS
Chair, Urologic Diagnostic and Therapeutic Imaging Committee
From AUANews article, January 2012
The Urologic Ultrasound Task Force, a subcommittee of the Urologic Diagnostic and Therapeutic Imaging Committee, has worked with the leadership of the American Institute of Ultrasound in Medicine (AIUM) to develop a program whereby urology practices may seek accreditation for the performance of urological ultrasound. This is a voluntary program developed so that urology practices can demonstrate through an objective third party (AIUM) that high quality imaging is being performed in a safe environment by trained providers.

The collaboration between the AUA and AIUM resulted in 2 highly significant developments.

1. For the first time urological ultrasound has been recognized as a specific category of ultrasound imaging, similar to the categories of gynecological or musculoskeletal imaging.
2. Specific guidelines have been approved for performing renal, scrotal and prostate ultrasound in the context of urological practice. The guidelines establish the basic indications for performing these studies, and delineate the technique and basic findings that should be documented.

The key features of the accreditation program specific to urology are summarized.

Richard Rutherford
Former Director, AUA Practice Management Department:
Accreditation now under the auspices of the AUA/AIUM collaboration is just good business. Already, some payers in certain parts of the country who establish policies through radiology utilization management companies are limiting reimbursement if providers are not running an accredited ultrasound program in their office. We expect this trend to continue to grow as the payers migrate from straight fee-for-service business models to value-based purchasing models.

It is not that insurance companies will pay more to accredited facilities. They are looking at methods to encourage the facilities they do pay to demonstrate quality. Accreditation is one of those methods. Over time, as the health care delivery system evolves under current legislation, demonstrable baseline quality will be prerequisites to be considered as a network provider. If a urology practice does not meet certain prerequisites (such as running an accredited imaging program), government-funded programs will not be allowed to reimburse for imaging on patients in an accountable-care network. This evolution will take place at a different pace in different locations, so those who act now will be prepared. In addition, this type of accreditation is good for patients.

Stephanie N. Stinchcomb, CC, CCS-P
Senior Manager, AUA Reimbursement and Regulation Department:
Practices have been receiving denials for the technical component of urologic ultrasounds performed. Insurers have been requiring accreditation of practices through the AIUM. The problem was there was no accreditation program available specifically for urology ultrasounds. The AUA and AIUM decided that in order to protect reimbursement of ultrasound procedures performed in the urology practice, this accreditation program was necessary. Blue Cross Blue Shield of Massachusetts was one of the first insurers to require accreditation. We were able to convince the Radiology Benefit Managers and Medical Directors of BCBS to allow continuation of reimbursement until the accreditation program through AIUM for urology practices was completed. According to the BCBS Medical Director, once this program is accepted in one Blue Cross Blue Shield affiliate, it will be adopted throughout the United States. This program allows urology practices to continue to perform high quality ultrasounds and to receive reimbursement for procedures vital to the diagnosis and treatment of our urological patients.