CMS Radiology and Nuclear Medicine Hospital Conditions of Participation

Product Id : HE136
Instructor : Sue Dill Calloway
Jul 30, 2019 1:00 PM ET | 12:00 PM CT | 10:00 AM PT | 90 Minutes

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This program will cover all of the hospital radiology and nuclear medicine standards requires for hospitals from CMS. Even though CMS rewrote all of the hospital conditions of participation on radiology and nuclear medicine on July 10, 2015 there are some hospitals that are still struggling to comply. If a surveyor showed up at your door tomorrow would you are able to demonstrate compliance with the 41 pages of changes? Every hospital that accepts Medicare or Medicaid must be in compliance with these regulations and interpretive guidelines.

These address the issue that ionizing radiation can cause cancer and that radiology services are not without risk. Patient exposure to radiation has doubled in twenty years. The amount of ionizing radiation from a CT scan is significantly greater and patients may receive several over their life time. In fact, there are 80 million studies done every year. The FDA has taken initiative to reduce unnecessary radiation exposure. The FDA wants to make sure it is justified to use it and dose optimized so the lowest dose is used. This is referred to as low as reasonably achievable. CMS discusses safety precautions a hospital should do to decrease radiation exposure.

his program will cover the MRI requirements. There are many policies and protocols that are now required. This program will help hospitals understand all the radiology and nuclear medicine conditions of participation to help prevent receiving a deficiency.

Learning Objectives:

  • Recall that CMS rewrote has radiology and nuclear medicine provisions in the hospital CoP manual
  • Discuss that there are a number of policies and procedures required for radiology by CMS
  • Describe that the hospital must have diagnostic radiology services that meet standards of care and standards of practice
  • Recall that an order is needed for any radiology or nuclear medicine test

Session Agenda:

  • How to locate a copy of the current CMS CoP manual?
  • The risk of ionizing radiation
  • Increased patient exposure and the risk of cancer
  • Safety precautions to decrease radiation exposure
    • Trained staff, identify high risk patient, appropriate shielding, inspect and calibrate the equipment
  • FDA initiative to reduce unnecessary radiation exposure
  • Diagnostic radiology and standards
  • Therapeutic radiology and standards
  • Required policies and procedures
  • CT scans, radiation therapy, ultrasound, MRI. DEXA scan etc.
  • Radiology services to meet the needs of patients
  • Badge tests or exposure meters for radiation
  • Monitoring for quality and safety in radiology services
  • Blue boxes
  • Need qualified director of radiology
  • Reports signed by practitioner who interpreted them
  • Record retention period
  • Nuclear Medicine guidelines

Who Will Benefit:

  • Radiology department director
  • Radiology medical director
  • Radiology staff
  • Patient safety officer
  • Compliance officer
  • Regulatory affairs officers
  • Chief medical officer (CMO)
  • Emergency department physicians
  • Physicist
  • or any person in charge to ensure compliance with CMS guidelines on radiology and nuclear medicine.
Speaker Profile:

Sue Dill Calloway, RN, MSN, JD, is the president of Patient Safety and Healthcare Consulting and Education company with a focus on medical-legal education especially Joint Commission and the CMS hospital CoPs regulatory compliance. She also lectures on legal, risk management and patient safety issues. She was a director for risk management and patient safety for five years for the Doctors Company. She was the past VP of legal services at a community hospital in addition to being the privacy officer and the compliance officer. She was a medical malpractice defense attorney for ten years. She has 3 nursing degrees in addition to a law degree.

She is a well-known lecturer and the first one in the country to be a certified professional in CMS. She also teaches the course for the CMS certification program. She has written 102 books and thousands of articles.

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