Utilization Campaign Definitions

Computed Tomography Scan (CT)
A computerized x-ray procedure that produces cross-sectional images of the body layer-by-layer. These images are more detailed than regular x-ray films, and can reveal disease or abnormalities in tissue and bone.
Credentialing
A systematic approach to assessing a provider's qualifications and record on issues relating to professional competence and conduct. This includes a review of relevant training, academic background, experience, licensure, certification, and registration to practice in a health care field.
Dual Energy X-Ray Absorptiometry (DEXA)
An instrument that uses the energy from very small doses of x-rays to determine bone mineral density (BMD) and body composition as well as to diagnose and follow the treatment of osteoporosis.
In-office Self-Referral
The practice of nonradiologist physicians purchasing and installing their own imaging equipment in-office and subsequently performing and interpreting the imaging tests themselves in lieu of referring patients to a radiologist.
Magnetic Resonance Imaging (MRI)
A large noninvasive device that uses radio waves in a high strength magnetic field-instead of x-rays-to create nondestructive, three-dimensional, internal images of the soft tissues of the body, including the brain, spinal cord, and muscle. Images can be produced in any chosen plane.
Nonradiologist
A physician who, after attending medical school, enters into a residency program other than radiology-be it internal medicine (cardiologists, pulmonologists, urologists), general practitioner, surgery (orthopedics), neurology, ob-gyn, and so forth-and receives the formal education and training needed to practice that particular field of medicine. As a result of not attending a radiology residency, these physicians do not receive extensive formal instruction in the application and interpretation of diagnostic imaging services. Included in this grouping are chiropractors and podiatrists.
Nuclear Medicine
A specialized area of radiology that uses very small amounts of radioactive substances to examine organ function and structure. Radioactive elements are used to tag compounds that are injected into or ingested by the patient. The labeled compounds are preferentially absorbed by different organs. As the compounds are accumulated, the radioactive material is measured, creating a two-dimensional image that spatially indicates the varying concentrations.
Outpatient Services
Medical and other services provided by a qualified facility where an overnight stay is not required, such as therapy and other clinics, labs, and diagnostic centers.
Positron Emission Tomography Scan (PET)
Uses an array of stationary detectors around the patient and using the spatial 180 degree opposing properties of the 0.511-MeV annihilation radiation from positron-emitting radioactive tracers deposited in the organ or region of interest. The name tomography refers to the fact that the scanner computes a "slice" of the scanned object, not just a flat image. Each slice really is a volumetric (tomo-) image (-graphy). Employed to detect cancer in the body as well as to study the activity of the brain.
Radiologist
A physician who, after attending medical school, enters into a four- to five-year residency program in which he or she receives explicit instruction in applying and interpretating diagnostic imaging services. When a physician needs a diagnostic imaging test run on a patient, he or she writes a referral for the patient to see a radiologist to have the test performed. The radiologist examines the test results and relays the findings to the referring physician.
RVU (Relative value units)
This is a unit that measures the resources necessary to provide a given service in a physician's office. RVUs are used by the Center for Medicare and Medicaid Services (CMS) to calculate Medicare payment rates for physicians.
Self-Referral
The practice of physicians referring patients to diagnostic imaging facilities in which they have a vested financial interest.
The Stark Laws
Section 1877 of the Social Security Act (the Act), also known as the physician self-referral law: (1) Prohibits a physician from making referrals for certain ''designated health services'' (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership or compensation) unless an exception applies; and (2) prohibits the entity from filing claims with Medicare for those referred services, unless an exception applies. The statute establishes a number of specific exceptions and grants the Secretary the authority to create regulatory exceptions for financial relationships that pose no risk of fraud or abuse.
One of the exceptions is the "in-office ancillary services" exception. This loophole allows nonradiologists to purchase, install, and bill for diagnostic imaging services regardless of the practitioner's background and training in diagnostic imaging.