Application for Certification Adult …Application for Certification Adult Echocardiography (ASCeXAM) Certification Requirements and Online Certification Instructions National Board

Application for Certification

Adult Echocardiography (ASCeXAM)

Certification Requirements and Online Certification Instructions

National Board of Echocardiography, Inc.® 1500 Sunday Drive, Suite 102 • Raleigh, NC 27607

Phone: 919-861-5582 • Email: [email protected] Website: www.echoboards.org

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Contents

General Information Introduction .........................................................................................................................................................................................................................4

Eligibility ..............................................................................................................................................................................................................................4

Certification ApplyingforCertification ..............................................................................................................................................................................................5-6

BoardCertificationRequirements ...............................................................................................................................................................................7-11

Special Circumstances ....................................................................................................................................................................................................................12

OnlineCertificationInstructions ...................................................................................................................................................................................13

Sample Letters ............................................................................................................................................................................................................. 14-16

Please check our website at www.echoboards.org for future application deadlines.

4

Introduction

National Board of Echocardiography, Inc.TheNationalBoardof Echocardiography,Inc.(NBE)wasformedinDecember1998.TheNBEisanot-for-profitcorporationestablishedto:

• Developandadministerexaminationsinthefieldof ClinicalEchocardiography,

• Recognize those physicians who successfully complete either the examination of Special Competence in Adult Echocardiography (ASCeX-AM) or the Perioperative Transesophageal Echocardiography examination (PTE), and

• Developacertificationprocessthatwillpubliclyrecognizethosephysicianswhohavecompletedanapprovedtrainingprograminechocar-diographyasspecifiedinthisapplicationandhaveadditionallypassedtheASCeXAM.

Theexaminationandcertificationof SpecialCompetenceinEchocardiographyarenotintendedtorestrictthepracticeof echocardiography.The process is undertaken, rather, in the belief that the public desires an indication from the profession regarding those who have made the ef-fort to optimize their skill in the performance and interpretation of cardiac ultrasound.

Thefirstexaminationinclinicalechocardiographywasgivenundertheauspicesof theAmericanSocietyof Echocardiography(ASE)asafieldtest in 1995. An examination of special competence was given in 1996, again under the ASE, and in 1997 and 1998 under ASCeXAM, Inc. Since 1999, the exam has been administered annually by the NBE. For these examinations, the title of “Testamur” was designated for successfully passingtheexamination.Thisdesignationwaschosensinceapplicantswerenotrequestedtosupplyinformationregardingsuccessfulcomple-tion of training dedicated to the study of Adult Cardiovascular Disease nor completion of special training in echocardiography. With a mature andwell-testedexamination,awell-definedbodyof knowledge,publishedtrainingguidelines,andpublishedcontinuingqualityimprovementguidelines,theNBEbeganofferingcertificationin2001.

Eligibility

CertificationTheCertificationCommitteewillmeettoreviewapplicationsforcer-tification.Applicantswillbenotifiedinwritingof thedecisionof theCommittee.Reviewof applicationforcertificationwillbecontingentonsuccessfulcompletionof theASCeXAM.Applicantswillreceivenotifica-tion of the decision of the Committee within the year.

Individuals who pass the ASCeXAM and who have completed Adult CardiovascularDiseaseandechocardiographytrainingrequirementsbyJune30,2009mayapplyforcertificationatanypointinwhichtheymeettheclinicalexperiencerequirements,aslongastheirTestamurstatusremains valid.

Individuals who completed training after June 30, 2009, and failed to meet therequirementsforcertificationduringfellowshiptraining,canonlyqualifyforcertificationbyobtainingadditionaltraininginanACGMEaccredited or other nationally accredited training program.

Please refer to page 10 for additional information.

Testamur StatusForlicensedphysiciansnotmeetingthecriteriaforcertification,theNBEwill continue to allow access to the examination. This is to encourage physicians to test and demonstrate their knowledge of echocardiography based on an objective standard and to allow the medical community the opportunity to recognize individuals who elect to participate in and suc-cessfully complete a comprehensive examination in echocardiography. Thosewhosuccessfullypasstheexaminationbutdonotfulfilltheneces-sarycriteriaforcertificationwillcontinuetobedesignatedas“Testamur”by the National Board of Echocardiography.

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Policy NoticeDefinitionof Interpretation:

Interpretation by a Trainee is defined to be independent reading and reporting of an echocardiographic study followed by review with, or under the direct supervision of, an attending physician. Studies read by an attending with the trainee as an observer are not to be counted.

While this has always been the intention of the NBE, this strict definitionwillbeappliedtofellowswhobegantheirtrainingonorafter July 1, 2010.

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Applying for Certification

Who May Apply?Licensedphysicianswhomeetthecriteriamayapplyforcertificationatthetimeof applicationfortheASCeXAM.TheCertificationCommitteewillmeettoreviewapplications,andapplicantswillbenotifiedinwritingof thedecisionof theCommittee.Reviewof applicationforcertificationwill be contingent on successful completion of the ASCeXAM. Appli-cantswillreceivenotificationof thedecisionof theCommitteewithin12months.

The Purposes of the Certification Process:• establish the domain of the practice of echocardiography for the

purposeof certification,

• assess the level of knowledge demonstrated by a licensed physician practitioner of echocardiography in a valid manner,

• enhancethequalityof echocardiographyandindividualprofessionalgrowth in echocardiography,

• formallyrecognizeindividualswhosatisfytherequirementssetbytheNBE, and

• servethepublicbyencouragingqualitypatientcareinthepracticeof echocardiography.

Levels of Certification Offered:• Transthoracic 2-D and Doppler Echocardiography

interpretation alone (t)

• Transesophageal Echocardiography (e)

• Transthoracic plus Transesophageal Echocardiography (te)

• Transthoracic plus Stress Echocardiography (ts)

• Comprehensive (c) which includes all three procedures

PhysicianswhohavebeencertifiedinTransthoracicEchocardiog-raphy (or higher) by the NBE and completed adult cardiovascular disease training prior to July 1, 2009 may apply for additional certificationoncetheirlevelof serviceinthoseareasmeetstheminimumrequirements(seepage11)

PhysicianswhohavebeencertifiedinTransthoracicEchocardiog-raphy (or higher) by the NBE and completed adult cardiovascular disease training between July 1, 2008, and June 30, 2009, must wait three years from the end of their fellowship program to ap-plyforanadditionalcertificationlevel(e.g.,addingstressand/ortransesophagealechocardiographycertification)underthepracticeexperience pathway, or they must obtain additional training in an ACGME accredited or other nationally accredited fellowship program.

PhysicianswhohavebeencertifiedinTransthoracicEchocar-diography (or higher) and completed adult cardiovascular disease training after June 30, 2009, are only eligible to apply for ad-ditionalcertification(e.g.,addingstressand/ortransesophagealechocardiographycertification)byobtainingadditionaltraininginan ACGME accredited or other nationally accredited fellowship program.


6

Applying for Certification

Certification Documentation and InstructionsThe National Board of Echocardiography, Inc. reserves the right to audit stated clinical experience and continued provision of services in echocar-diographyforthesakeof eligibilityforcertification.

Letters Documenting Training and/or Level of Service:

All letters documenting training and/or level of service MUST be on appropriate letterhead, MUST be notarized, MUST contain EXACT numbers of studies performed and interpreted, and MUST be the original letter (no copies accepted). Applications with letters not meeting these criteria will not be reviewed. Sample letters are available on pages 14-16 and on our website: www.echoboards.org.

Lettersdocumentingtrainingand/orlevelof servicefromDivisionorDepartment Head of Cardiovascular Disease, the Fellowship Training Di-rector, Director of Cardiovascular Anesthesiology, the Training Director, or the Medical Director* of the Echocardiography Laboratory (Level III) MUST be on appropriate letterhead and MUST be notarized.

For applicants who completed their fellowship after July 1, 2009, a state-ment from the Training Director must be included that indicates that the applicanthastheclinicalcompetenceandprofessionalqualitiesnecessaryto perform as an independent echocardiographer. In the absence of a formal director of the echocardiography laboratory, the letter should be written by an appropriate supervising physician.

*Note: If applicant is the Medical Director of the Echocardiography Laboratory, the letter should be from the Chief of Cardiology or the Chief of Staff of the Hospital.

If applicantsareinprivatepracticeandservicesareprovidedintheoffice,the letter documenting level of service must be on appropriate letterhead and should be written by the CEO or President of the practice. If the applicant is the CEO or President of the practice, the letter should be written by the business manager.

For the purpose of certification, a study performed and/or in-terpreted may be counted only once and must be counted under the code that it was billed. Example: Even though a full TTE is performed as part of a Stress Echo with only a single bill being submitted (93350), the study must be counted as a Stress Echo and cannot be counted as both a TTE and a Stress.

Werequestthatthenotarizedlettersverifyingthenumberof studiesperyear for the appropriate time, 2 or 3 years broken down by procedure code in the following format.

Yr. 1 (2014) Yr. 2 (2015) Yr. 3 (2016)Transthoracic (93303-93308) ### ### ###Transesophageal (93312-93317) ### ### ###Stress Echo (93350) ### ### ###

NOTE: The numbers provided must be in parallel, consecutive years but need not be calendar years. If using a fiscal year, exact dates are required. For example: MM/DD/YY - MM/DD/YY. The end of the most recent year for which credit is requested must fall within the 12 months prior to receipt of the complete application.

The EXACT number of studies performed and interpreted per year MUST be provided. Committee decisions will be determined using the numbers provided in this letter. Applications containing ap-proximatedand/orroundednumberswillnolongerbereviewedbytheCertificationCommittee.

Review of Documentation for CertificationSincecertificationisdependentonpassingtheASCeXAM,applicationsforcertificationarereviewedaftertheexaminationhasbeensatisfactorilycompleted.

Effective Date of CertificationCertificationwillberetroactivetothedatethattheSpecialCompetencyExam (ASEeXAM or ASCeXAM) was passed and will be valid for ten (10)yearsfromthatdate;e.g.,if theexamwaspassedin1999,certifi-cation will be valid until June 30, 2009. If the exam is passed in 2017, certificationwillbevaliduntilJune30,2027.

Policy NoticeDefinitionof Interpretation:

Interpretation by a Trainee is defined to be independent reading and reporting of an echocardiographic study followed by review with, or under the direct supervision of, an attending physician. Studies read by an attending with the trainee as an observer are not to be counted.

While this has always been the intention of the NBE, this strict definitionwillbeappliedtofellowswhobegantheirtrainingonorafter July 1, 2010.

Change in Certification PolicyThischangeinCertificationPolicyaffectsallfellowswhowillcom-plete their training after June 30, 2009 (i.e., those who began their trainingonorafterJuly1,2006).Specifically,fellowscompletingtheirfellowshipafterJune30,2009,canONLYqualifyforcertificationbycompleting level II training in echocardiography (6 months of formal training in echocardiography) during their fellowship, including the satisfactory performance of at least 150 transthoracic echocardiograms and the interpreting of at least 300 transthoracic studies. Additional certification in stress echocardiography requires the performanceand interpretation of at least 100 stress echocardiograms, while ad-ditional certification in transesophageal echocardiography requiresthe performance of at least 50 transesophageal echocardiograms. Individuals who fail to satisfy these requirements during their fellowship can only qualify for certification by obtaining addi-tional training in an ACGME accredited or other nationally ac-credited fellowship program. For this group, practice experience will no longer be accepted as an alternative to formal training.


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Board Certification Requirements

BOARD CERTIFICATION REQUIREMENTS 1-4 REQUIRED DOCUMENTATION

Certification Levels• Comprehensive Certification (c) – Includes all Three - Transthoracic, Transesophageal, and Stress Echocardiography

• Transthoracic Certification (t) – Transthoracic (Cardiovascular Clinician)

• Transesophageal Echocardiography (te) - Transthoracic Plus Transesophageal Echocardiography (Cardiovascular Clinician) (e) - Transesophageal Echocardiography Alone (Cardiovascular Anesthesiologist, Cardiovascular Surgeon)

• Transthoracic Plus Stress Echocardiography Certification (ts)

What Are the Six Requirements?Requirements 1-4andSupportingDocumentation,whicharethesameforalllevelsof certification,arelistedbelow.

Requirement 5,seetheAdultCardiovascularDiseaseTrainingTimeTablespecifictoyourclinicaltraining.

Requirement 6, the Application Fee.

Requirement 1. Testamur of the ASCeXAM.

Requirement 2. Certification Eligibility License Requirements.Applicantswhowishtoapplyforcertificationmustholdavalid,unre-stricted license to practice medicine at the time of application. (Geo-graphical restrictions may be accepted and are subject to approval.) Medi-cal restrictions or restrictions to scope of practice will not be accepted for purposesof eligibilityforcertification.

Requirement 3. Current Medical Board Certification.Applicantsmustbeboardcertifiedbyaboardthatholdsmembershipinthe American Board of Internal Medicine, the Advisory Board for Osteo-pathic Specialties, the American Association of Physician Specialists, or Royal College of Physicians and Surgeons of Canada.

Requirement 4. Specific Training in Adult Cardiovascular Disease.Applicants must have a minimum of 24 months of specialized clinical training dedicated to the study of adult cardiovascular disease. This train-ing is to be at the fellowship level. Fellowship training in adult cardiovas-cular disease must be obtained at an ACGME accredited training program or other nationally accredited adult cardiovascular training program. That is, cardiovascular rotations during general internal medicine, surgery, radiology, anesthesiology, or other general residencies cannot be counted towardsthisrequirement.Monthsspentincardiovascularresearchmaynotbecountedtowardthisrequirement.

Requirement 1.Provide year ASCeXAM passed

If applyingforcertificationandexam,provideyearyou’retakingtheexam.

Requirement 2. (One of the following):

• Copyof currentmedicallicenserenewalcertificatethatshowsanexpiration date.

• Copyof equivalentdocumentationof permissiontopracticemedicinein the country of principal residence.

Requirement 3.Copyof certificateof highestBoardCertificationattained,e.g.,InternalMedicine, Cardiovascular Disease, Anesthesiology, etc. (A copy of ABIM CertificationinCardiovascularDiseaseispreferred.)

Requirement 4. (One of the following):

• Copyof acertificateof successfulcompletionof anaccreditedfel-lowship in adult cardiovascular disease.

• An original notarized letter on appropriate letterhead from the Division or the Department Head of Cardiovascular Disease or Fellowship Training Director stating the applicant has successfully completed an approved Adult Cardiovascular Disease Fellowship and the date of completion.

• An original notarized letter on appropriate letterhead from the hospi-tal or appropriate departmental Training Director stating the applicant hascompletedafull24monthsof clinicaltrainingdedicatedspecifi-cally to adult cardiovascular disease. The letter must document the inclusive dates of the training and the number of echoes performed and interpreted during training. A summary of the training program activitiesisrecommended(seeLettersDocumentingTrainingand/orLevel of Service: page 6).

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9


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the

Trai

ning

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ctor

indi

cat-

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that

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ican

t has

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clin

ical

com

pe-

tenceandprofessionalqualitiesnecessaryto

perf

orm

as

an in

depe

nden

t ech

ocar

diog

raph

er.

Req

uire

men

t 5. T

he a

pplic

ant m

ust h

ave

com

plet

ed L

evel

I T

rain

ing

(3 m

onth

s tr

aini

ng

with

per

form

ance

and

inte

rpre

tatio

n of

150

tr

anst

hora

cic

echo

card

iogr

ams)

and

hav

e pr

o-vi

ded

echo

card

iogr

aphy

stu

dies

of

at le

ast 4

00

2-DimensionalEcho/Dopplerstudiesand50

tran

seso

phag

eal e

choc

ardi

ogra

ms

per y

ear f

or

each

of

two

year

s im

med

iate

ly p

rece

ding

this

ap

plic

atio

n.

Supp

orti

ng D

ocum

enta

tion

: An

orig

inal

no

tariz

ed le

tter o

n ap

prop

riate

lette

rhea

d ve

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ng th

e nu

mbe

r of

2-D

imen

sion

al

Echo/Dopplerstudiesandtransesophageal

echo

card

iogr

ams

perf

orm

ed.

Req

uire

men

t 5. T

he a

pplic

ant m

ust h

ave

prov

ided

ech

ocar

diog

raph

y se

rvic

es o

f at

leas

t 4002-DimensionalEcho/Dopplerstud-

ies

per y

ear f

or e

ach

of th

e th

ree

(3) y

ears

im

med

iate

ly p

rece

ding

this

app

licat

ion

and

have

per

form

ed a

nd in

terp

rete

d at

leas

t 50

tran

seso

phag

eal e

choc

ardi

ogra

ms

per y

ear f

or

each

of

two

(2) y

ears

imm

edia

tely

pre

cedi

ng

this

app

licat

ion.

Supp

orti

ng D

ocum

enta

tion

: An

orig

inal

no

tariz

ed le

tter o

n ap

prop

riate

lette

rhea

d ve

ri-fyingthenumberof2-DimensionalEcho/

Dop

pler

stu

dies

and

the

tran

seso

phag

eal

echo

card

iogr

ams

perf

orm

ed.

Trans

esop

hage

al

Echo

card

iogra

phy

Certi

ficat

ion (e

)

Req

uire

men

t 5. T

he a

pplic

ant m

ust h

ave

perf

orm

ed a

nd in

terp

rete

d at

leas

t 300

tran

s-es

opha

geal

ech

ocar

diog

ram

s w

ithin

a tr

aini

ng

prog

ram

.

Supp

orti

ng D

ocum

enta

tion

: An

orig

inal

no

tariz

ed le

tter o

n ap

prop

riate

lette

rhea

d fr

om th

e ho

spita

l or a

ppro

pria

te d

epar

tmen

tal

Trai

ning

Dire

ctor

, e.g

., D

irect

or o

f C

ardi

ovas

-cu

lar A

nest

hesi

olog

y, st

atin

g th

e ap

plic

ant h

as

com

plet

ed a

full

24 m

onth

s of

clin

ical

trai

ning

dedicatedspecificallytoadultcardiovascu-

lar d

isea

se. T

his

lette

r mus

t doc

umen

t the

in

clus

ive

date

s of

the

trai

ning

and

the

num

ber

of tr

anse

soph

agea

l ech

oes

perf

orm

ed d

urin

g tr

aini

ng. A

sum

mar

y of

the

trai

ning

pro

gram

ac

tiviti

es is

reco

mm

ende

d.

Req

uire

men

t 5. T

he a

pplic

ant m

ust h

ave

perf

orm

ed a

nd in

terp

rete

d at

leas

t 150

tr

anse

soph

agea

l ech

ocar

diog

ram

s du

ring

the

trai

ning

pro

gram

and

per

form

ed a

t lea

st 1

00

tran

seso

phag

eal e

choc

ardi

ogra

ms

per y

ear f

or

each

of

two

(2) y

ears

imm

edia

tely

pre

cedi

ng

appl

icat

ion.

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orti

ng D

ocum

enta

tion

: An

orig

inal

no

tariz

ed le

tter o

n ap

prop

riate

lette

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d fr

om th

e Tr

aini

ng D

irect

or o

r the

Med

ical

Di-

rect

or o

f Tr

anse

soph

agea

l stu

dies

per

form

ed

for e

ach

of th

e tw

o (2

) yea

rs p

rece

ding

this

ap

plic

atio

n.

Req

uire

men

t 5. T

he a

pplic

ant m

ust h

ave

perf

orm

ed a

t lea

st 1

00 tr

anse

soph

agea

l ech

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rdio

gram

s pe

r yea

r for

eac

h of

the

thre

e (3

) ye

ars

imm

edia

tely

pre

cedi

ng a

pplic

atio

n.

Supp

orti

ng D

ocum

enta

tion

: An

orig

inal

no

tariz

ed le

tter o

n ap

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riate

lette

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d fr

om th

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aini

ng D

irect

or o

r the

Med

ical

D

irect

or o

f th

e E

choc

ardi

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phy

Lab

(Lev

el

III)

ver

ifyin

g th

e nu

mbe

r of

tran

seso

phag

eal

stud

ies

perf

orm

ed fo

r eac

h of

the

thre

e (3

) ye

ars

prec

edin

g th

is a

pplic

atio

n.

Trans

thor

acic

Plus

St

ress

Ech

ocar

diogr

a-ph

y Cer

tifica

tion

(ts)

Req

uire

men

t 5. T

he a

pplic

ant m

ust h

ave

com

plet

ed L

evel

II

Trai

ning

(6 m

onth

s tr

ain-

ing

with

per

form

ance

of

150

and

inte

rpre

ta-

tion

of 3

00 tr

anst

hora

cic

echo

card

iogr

ams)

an

d pa

rtic

ipat

ed in

and

inte

rpre

ted

at le

ast 1

00

stre

ss e

choc

ardi

ogra

ms

durin

g tr

aini

ng.

Req

uire

d D

ocum

enta

tion

: An

orig

inal

not

a-riz

ed le

tter o

n ap

prop

riate

lette

rhea

d fr

om th

e Tr

aini

ng D

irect

or o

r the

Med

ical

Dire

ctor

of

the

Ech

ocar

diog

raph

y La

b (L

evel

III

) ver

ifyin

g co

mpl

etio

n of

Lev

el I

I Tr

aini

ng, t

he d

ates

of

trai

ning

, and

the

num

ber o

f tr

anst

hora

cic

and

stre

ss e

choe

s pe

rfor

med

dur

ing

trai

ning

. T

he le

tter m

ust i

nclu

de a

sta

tem

ent f

rom

the

Trai

ning

Dire

ctor

indi

catin

g th

at th

e ap

plic

ant

has

the

clin

ical

com

pete

nce

and

prof

essi

onal

qualitiesnecessarytoperformasanindepen-

dent

ech

ocar

diog

raph

er.

Req

uire

men

t 5. T

he a

pplic

ant m

ust h

ave

com

plet

ed L

evel

I T

rain

ing

(3 m

onth

s tr

ain-

ing

with

per

form

ance

and

inte

rpre

tatio

n of

150

tran

stho

raci

c ec

hoca

rdio

gram

s) a

nd

have

pro

vide

d ec

hoca

rdio

grap

hy s

ervi

ces

of

atleast4002-DimensionalEcho/Doppler

stud

ies

and

100

stre

ss e

choc

ardi

ogra

ms

per

year

for e

ach

of tw

o (2

) yea

rs im

med

iate

ly

prec

edin

g th

is a

pplic

atio

n.

Req

uire

d D

ocum

enta

tion

: An

orig

inal

no-

tariz

ed le

tter o

n ap

prop

riate

lette

rhea

d ve

rify-

ingthenumberof2-DimensionalEcho/

Dop

pler

stu

dies

and

str

ess

echo

card

iogr

ams

perf

orm

ed.

NO

TE

: The

num

bers

pro

vide

d m

ust b

e in

pa

ralle

l, co

nsec

utiv

e ye

ars

and

are

not l

imite

d to

calendaryears.Ifusingafiscalyear,mustdocu-

mentM

M/DD/YY-MM/DD/YY.

Req

uire

men

t 5. T

he a

pplic

ant m

ust h

ave

prov

ided

ech

ocar

diog

raph

y se

rvic

es o

f at

leas


per y

ear f

or e

ach

of th

ree

(3) y

ears

imm

e-di

atel

y pr

eced

ing

this

app

licat

ion,

and

hav

e pe

rfor

med

and

inte

rpre

ted

at le

ast 1

00 s

tres

s ec

hoca

rdio

gram

s pe

r yea

r for

eac

h of

two

(2)

year

s im

med

iate

ly p

rece

ding

this

app

licat

ion.

Req

uire

d D

ocum

enta

tion

: An

orig

inal

no

tariz

ed le

tter o

n ap

prop

riate

lette

rhea

d ve

ri-fyingthenumberof2DimensionalEcho/

Dop

pler

stu

dies

and

str

ess

echo

card

iogr

ams

perf

orm

ed.

NO

TE

: The

num

bers

pro

vide

d m

ust b

e in

pa

ralle

l, co

nsec

utiv

e ye

ars

and

are

not l

imite

d tocalendaryears.Ifusingafiscalyear,must

documentM

M/DD/YY-MM/DD/YY.

IMP

OR

TA

NT

: If

you

com

plet

ed tr

aini

ng

afte

r Ju

ne 3

0, 2

009,

and

yo

u fa

iled

to m

eet t

he

requ

irem

ents

for

cert

i-fic

atio

n du

ring

trai

ning

, pl

ease

ref

er to

pag

e 5

and

page

10

for

addi

-ti

onal

info

rmat

ion.

IMP

OR

TA

NT

: If

you

com

plet

ed tr

aini

ng

afte

r Ju

ne 3

0, 2

009,

and

yo

u fa

iled

to m

eet t

he

requ

irem

ents

for

cert

i-fic

atio

n du

ring

trai

ning

, pl

ease

ref

er to

pag

e 5

and

page

10

for

addi

-ti

onal

info

rmat

ion.

IMP

OR

TA

NT

: If

you

com

plet

ed tr

aini

ng

afte

r Ju

ne 3

0, 2

009,

and

yo

u fa

iled

to m

eet t

he

requ

irem

ents

for

cert

i-fic

atio

n du

ring

trai

ning

, pl

ease

ref

er to

pag

e 5

and

page

10

for

addi

-ti

onal

info

rmat

ion.

10

*For physicians less than 3 years out of training:

Must make-up the difference to meet Level II training requirements

• Must have a minimum of 6-months in the echo lab

• Meet minimum numbers for TTE (150, 300) along with TEE(50)andStress(100),if desiredforcertification

IndividualswhofailtosatisfytheserequirementsduringtheirfellowshipcanonlyqualifyforcertificationbyobtainingadditionaltraininginanACGME accredited or other nationally accredited fellowship program.

Physicians who complete training after June 30, 2009, and did meet Level II training requirements but wait more than 3 years to take the exam and apply for certification, must also meet one of the additional supplemental practice requirements: Pathway #1: a) meet the minimum practice numbers the 2 years prior to application, b) provide a minimum of 15 hours of AMAcategory1echo-specificCME,whichmustbeacquiredduringthesameyearsinwhichthenumbersareprovided.

Pathway #2: a) meet the minimum practice numbers the 2 years after initial application, b) provide a minimum of 15 hours of AMAcategory1echo-specificCME,whichmustbeacquiredduringthesameyearsinwhichthenumbersareprovided.

*For physicians more than 3 years out of training there are two pathways to certification:

Pathway #1: a) Meet the numbers needed for Level II (i.e. completewhatyouweredeficientin)atafacilitywithanACGME accredited adult cardiology fellowship training program or other nationally accredited adult cardiovascular training program, b) meet the minimum practice numbers the 2 years priortocompletingthedeficienttrainingnumbers, c) provide a minimum of 15-hours AMA category-1echo-specificCME.TheCMEmustbeacquiredduring the same years in which the numbers are provided.

Pathway #2: a) Meet the numbers needed for Level II (i.e. completewhatyouweredeficientin)atafacilitywithanACGME accredited adult cardiology fellowship training program or other nationally accredited adult cardiovascular training program, b) meet the minimum practice numbers the 2 years aftercompletingthedeficienttrainingnumbers,c) provide a minimum of 15-hours AMA category-1 echo-specificCME.TheCMEmustbeacquiredduringthesameyears in which the numbers are provided.

Requirements for Physicians that did not meet the required number of procedures during fellowship after June 30, 2009:

Physician Requirements

11

REQUIRED DOCUMENTATION

I. Additional Certification in Transesophageal EchocardiographyForthepurposeof certification,astudyperformedand/orinterpretedmaybe counted only once and must be counted under the code that it was billed. Example: Even though a full TTE is performed as part of a Stress Echo with only a single bill being submitted (93350), the study must be counted as a Stress Echo and cannot be counted as both a TTE and a Stress.

Requirement 1.ApplicantsmustbecurrentlycertifiedbytheNBEinTransthoracicorTransthoracic Plus Stress Echocardiography, and adult cardiovascular disease training must be completed prior to July 1, 2009.

Requirement 2.Applicants must show continued maintenance of skills in transesophageal echocardiography according to the following:

Performance and interpretation of at least 50 transesophageal echocar-diograms per year for each of the two (2) years immediately preceding this application.

Requirement 3.Application Fee $50.00 (US Funds)

Important: Please refer to the Policy Notice on page 5 for adding Additional Certification.

II. Additional Certification in Stress EchocardiographyForthepurposeof certification,astudyperformedand/orinterpretedmaybe counted only once and must be counted under the code that it was billed. Example: Even though a full TTE is performed as part of a Stress Echo with only a single bill being submitted (93350), the study must be counted as a Stress Echo and cannot be counted as both a TTE and a Stress.

Requirement 1.ApplicantsmustbecurrentlycertifiedbytheNBEinTransthoracicorTransthoracic Plus Transesophageal Echocardiography, and adult cardio-vascular disease training must be completed prior to July 1, 2009.

Requirement 2.Applicants must show continued maintenance of skills in pharmacologic or exercise stress echocardiography according to the following:

Primary interpretation of at least 100 stress echocardiograms per year for each of the two (2) years preceding this application.

Requirement 3.Application Fee $50.00 (US Funds)

Important: Please refer to the Policy Notice on page 5 for adding Additional Certification.


An original notarized letter on appropriate letterhead from the Medical Director of the Echocardiography Laboratory (Level III) verifying the number of transesophageal echocardiograms performed and interpreted per year for each of the two (2) years preceding this application (see LettersDocumentingTrainingand/orLevelof Service:page6).

Application fee may be paid by VISA or MasterCard in US Funds. The NBE does not accept American Express or Discover.

An original notarized letter on appropriate letterhead from the Medical Director of the Echocardiography Laboratory (Level III) verifying the number of Stress Echoes performed per year for each of the two (2) yearsprecedingthisapplication(SeeLettersDocumentingTrainingand/or Level of Service: page 6).

Application fee may be paid by VISA or MasterCard in US Funds. The NBE does not accept American Express or Discover.

BOARD CERTIFICATION REQUIREMENTS

12

Special CircumstancesOther Than 24 Months of Training in Adult Cardiovascular Disease

The NBE recognizes that other scenarios for obtaining 24 months of clinical training focused on cardiovascular disease are possible, albeit rare. ApplicantswhodonotmeetRequirement4fortransthoraciccertification(t)mayapplyforcertificationbyrequestingthatclinicalexperiencewithevidenceof stronginvolvementinadultcardiovasculardisease/echo-cardiographybeacceptedforupto12monthsof therequirementforformal training.

These applications will be evaluated on a case-by-case basis for eligibility.

(Please note that adult cardiovascular disease training during residency cannotbeincludedaspartof this24-monthrequirement.SeeRequire-ment 4, page 7.)

Requirements for Consideration for Certification with Less Than 24 Months of Adult Cardiovascular Disease Training

Requirements 1, 2, 3, and 6 of Transthoracic (t) Certification and each of the following:

• Aletterrequestingthatclinicalexperiencewithevidenceof stronginvolvementinadultcardiovasculardisease/echocardiographybeacceptedforupto12monthsof therequirementforformaltrainingmust be submitted.

• A notarized letter on appropriate letterhead from the person respon-sible for the training, with detailed documentation of the training activities, statement of successful completion, and the inclusive dates must be supplied.

• Anotarizedletterdetailingnational/regionalmeetingsattended,paperspresented, lectures given, and peer-reviewed publications in the realm of adultcardiovasculardiseaseand/orechocardiographymustbesubmitted.

• A notarized letter on appropriate letterhead documenting the number of transthoracic echocardiograms performed per year in each of the preceding three (3) years, and the number of transesophageal echocar-diograms and stress echocardiograms performed per year in each of theprecedingtwo(2)years(seeLettersDocumentingTrainingand/orLevel of Service: page 6).

Requirement 1 for Transthoracic (t) Certification:

Testamur of the ASEeXAM or ReASCE.


Acurrentlicenseorequivalentdocumentationof permissiontopracticemedicine in the country of principal residence.

Requirement 3 Transthoracic (t) Certification:

Documentationof specialtyboardcertificationoritsequivalent.


Documentation of 24 months of training dedicated to adult cardiovascu-lar disease.


Documentationof trainingequivalenttoLevelII(seeabove)inthethree(3)yearspriortothisapplication(if trainingwascompletedsubsequenttoJuly 1, 1999),

OR

Documentationof trainingequivalenttoLevelI(seeabove)andprovi-sionof thenumberof 2DEcho/Dopplerservicesperyearforeachof the two (2) years prior to this application if training was completed between July 1, 1990, and July 1, 1999,

OR

Documentationof provisionof thenumberof 2DEcho/Dopplerservicesper year for each of the three (3) years prior to this application if the training in adult cardiovascular disease was completed prior to July 1, 1990.

OR

Documentation of Accreditation by the British Society of Echocardiography.


Application fee.

Non-North American Trained PhysiciansNon-NorthAmericantrainedphysiciansmusthavehadtheequivalent*of eachof theapplicabletrainingand/orclinicalexperiencerequirementstobeeligibleforcertification.

Applications will be reviewed on a case-by-case basis to determine the eligibilityof theapplicantforcertification.Documentationmustincludethe inclusive dates of training.

“Equivalent”isdefinedassix(6)monthsof formaltraininginechocar-diographywithperformanceandinterpretationof atleast3002-DEcho/Doppler studies.

All documentation must be supplied in English. If original docu-mentation is not in English, a certified translation must be attached to each document.

Special Circumstances

Change in Certification PolicyThischangeinCertificationPolicyaffectsallfellowswhowillcom-plete their training after June 30, 2009 (i.e., those who began their trainingonorafterJuly1,2006).Specifically,fellowscompletingtheirfellowshipafterJune30,2009,canONLYqualifyforcertificationbycompleting level II training in echocardiography (6 months of formal training in echocardiography) during their fellowship including the satisfactory performance of at least 150 transthoracic echocardiograms and the interpreting of at least 300 transthoracic studies. Additional certification in stress echocardiography requires the performanceand interpretation of at least 100 stress echocardiograms, while ad-ditional certification in transesophageal echocardiography requiresthe performance of at least 50 transesophageal echocardiograms. Individuals who fail to satisfy these requirements during their fellowship can only qualify for certification by obtaining addi-tional training in an ACGME accredited or other nationally ac-credited fellowship program. For this group, practice experience will no longer be accepted as an alternative to formal training.


13

Online Certification Instructions

Please read the following instructions carefully:Please take a moment to review the appropriate handbook fordetailinstructions,pathways,andrequirementsbeforesubmittingdocumentationforcertification.

Step 1) Sign in to your existing NBE account on www.echoboards.org.

Step 2) CERTIFICATION: On the top of the Browser, youwillfindatabforCertification. In the drop down menu you may choose the option to EnrollforCertification.

Step 3) CHOOSE PROGRAM: Choose the program in which you would like to enroll to submit your Application forCertification.

Step 4) ENROLL:Enrollintheprogram.Aconfirmationwill appear that will approve your enrollment.

Step 5) UPLOAD DOCUMENTS: On the right side of thebrowser,youwillfindtheDocumentsUploader.Pleaseuploadallrequireddocumentationtocompleteyourapplica-tionforcertification.

Instructions to Upload Required Documents:• Forrequireddocumentswhichanapplicantcansupply

themselves, the documents must be scanned into a PDF file. Click on “My Documents Uploader” on the right side of the screen. The applicant will choose the Program thedocumentspertaintoandtheRequirementtheyfulfillfrom the drop-down lists.

Although an applicant may upload a copy of the notarized letter, the original notarized document is required to be mailed to the National Board of Echocardiography to complete the requirement. The original notarized letter must be mailed to the address below:

National Board of Echocardiography 1500 Sunday Dr., Suite 102 Raleigh, NC 27607

This letter must be signed, dated, notarized, and typed on officialletterhead.Thenotarizedletterwillnotbeacceptedas only a scanned upload, and must be post mailed to com-pletethisrequirement.Ascannedcopymaybeuploadedforthisrequirementtobeginreview;however,theapplicationwill not be complete until the original notarized letter is received by the National Board of Echocardiography. The Applicant may mail this OR the Program Director may mail this letter directly.

• The documents do not have to be uploaded in order. Please carefully review the appropriate handbooks to ensurecompletionof appropriaterequirements.

How to Track Progress:An applicant may track the progress of any submitted documentationbyfindingtheCertifications tab, and clicking Continue in your Program out of the drop down menu.

Theapplicantmayclickthehyperlink‘ViewProgress’forthe appropriate application.

RequirementswillbelistedasRequired,inProgress, or Complete.

Once the documents have been reviewed, the status will changeto‘InProgress’pereachrequirement.If require-mentsaremissing,orfurtherverificationisrequired,notifi-cationswillbeemailedtotheemailaddressonfile.

Once an application is complete and the original notarized letter is received and reviewed by NBE staff, the status will benotedas‘Complete’.ThisindicatestheapplicationiscompleteforCommitteereviewatthenextCertificationCommitteemeeting.PleasenotethatCertificationCommit-tee meetings are held twice a year. Applicants will receive notificationof thedecisionof thecommitteewithin12months.

How to View Current Submitted Documentation: An applicant may view previously submitted documents in the “My Documents Uploader”.

14

ABC Hospital123 Main Street • New York, NY 54321 • (212) 123-5432

Date

National Board of Echocardiography, Inc. 1500 Sunday Drive, Suite 102 Raleigh, NC 27607

RE: Physician’s Full Name Physician’s Date of Birth Physician’s Social Security Number ACGME Program Number

To Whom It May Concern:

Requirement 4: This letter serves to confirm that Dr. ____________________ successfully completed a minimum of 24 months of clinical adult cardiology training at our institution between ____________________ and ____________________ including completion of Level II echocardiography training and at least 6 months of specific training in the echocardiography laboratory. This letter further confirms that this program is an accredited ACGME training program or other nationally accredited adult cardiovascular disease training program.

Requirement 5: Our laboratory records indicate that __________ performed and interpreted echoes during training as follows:

Transthoracic Echoes (2-D and Doppler) Performed __________ Transthoracic Echoes (2-D and Doppler) Interpreted __________ Transesophageal Echoes Performed and Interpreted __________ Stress Echoes Participated In and Interpreted __________

In my opinion, Dr. ____________________ has the clinical competence and professional qualities necessary to perform as an independent echocardiographer.

q I certify that the number of studies provided above are exact numbers and are not rounded and/or estimates. (Please check box.)

Sincerely,

Name Title (Division or Department Head or Fellowship Training Director)

Sworn and subscribed to before me on (date): ____________________________________

_______________________________________________________________________ Signature of Notary Public

* NOTE: For the purpose of certification, a study performed and/or interpreted may be counted only once and must be counted under the code that it was billed. Example: Even though a full TTE is performed as part of a Stress Echo with only a single bill being submitted (93350), the study must be counted as a Stress Echo and cannot be counted as both a TTE and a Stress.

The EXACT number of studies performed and interpreted MUST be provided. Committee decisions will be determined using the numbers provided in this letter. Applications containing approximated and/or rounded numbers will no longer be reviewed by the Certification Committee. Letters docu-menting training MUST be on appropriate letterhead, MUST BE NOTARIZED, and MUST be the original letter.

Sample Letter

John Doe

(name)

Notary Seal

For physicians who completed fellowship less than 3 years out of Training

(he/she)

(date) (date)

(name)

(#)(#)(#)(#)

15

Sample Letter

Jane SmithNotary Seal

For physicians who completed fellowship PRIOR to July 1, 2009, and are in private practice or who completed training after June 30, 2009, and waited more than 3 years to take the examination

(name)(he/she)

ABC Practice123 Main Street • New York, NY 54321 • (212) 123-5432

Date


RE: Physician’s Full Name Physician’s Date of Birth Physician’s Social Security Number


ThisletterservestoconfirmthatDr.____________________isapracticingcardiologistinprivatepractice.Ourrecordsindicatethat __________ has performed and interpreted echoes as follows:

Yr. 1 (2014) Yr. 2 (2015) Yr. 3 (2016) Transthoracic (93303-93308) * #### #### #### Transesophageal (93312-93317)* #### #### Stress Echo (93350)* #### ####

q Icertifythatthenumberof studiesprovidedaboveareexactnumbersandarenotroundedand/orestimates. (Please check box.)

Sincerely,

Name Title (President, CEO, or Business Manager)




The EXACT number of studies performed and interpreted MUST be provided. Committee decisions will be determined using the numbers pro-vided in this letter. Applications containing approximated and/or rounded numbers will no longer be reviewed by the Certification Committee. Letters documenting level of service MUST be on appropriate letterhead, MUST BE NOTARIZED, and MUST be the original letter.

NOTE: The numbers provided must be in parallel, consecutive years but need not be calendar years. The end of the most recent year for which credit is requested must fall within the 12 months prior to receipt of the complete application. If using a fiscal year, exact dates are required. For example: MM/DD/YY - MM/DD/YY.

16

XYZ Hospital123 Main Street • New York, NY 54321 • (212) 123-5432

Date


RE: Physician’s Full Name Physician’s Date of Birth Physician’s Social Security Number


This letter serves to confirm that Dr. ____________________ is a practicing cardiologist working in our echocardiography lab. Our records indicate that __________ has performed and interpreted echoes as follows:

Yr. 1 (2014) Yr. 2 (2015) Yr. 3 (2016) Transthoracic (93303-93308)* #### #### #### Transesophageal (93312-93317)* #### #### Stress Echo (93350)* #### ####

q I certify that the number of studies provided above are exact numbers and are not rounded and/or estimates. (Please check box.)

Sincerely,

Name Title (Medical Director)**




The EXACT number of studies performed and interpreted MUST be provided. Committee decisions will be determined using the numbers pro-vided in this letter. Applications containing approximated and/or rounded numbers will no longer be reviewed by the Certification Committee. Letters documenting training MUST be on appropriate letterhead, MUST BE NOTARIZED, and MUST be the original letter.

NOTE: The numbers provided must be in parallel, consecutive years but need not be calendar years. The end of the most recent year for which credit is requested must fall within the 12 months prior to receipt of the complete application. If using a fiscal year, exact dates are required. For example: MM/DD/YY - MM/DD/YY.

** In the absence of a formal director of the echocardiography laboratory, the letter should be written by an appropriate supervising physi-cian. If applicant is the Medical Director of the Echocardiography Laboratory, the letter should be from the Chief of Cardiology or the Chief of Staff of the Hospital.

Sample Letter

Joe JonesNotary Seal

For physicians who completed fellowship PRIOR to July 1, 2009, and who work in a hospital setting or who completed training after June 30, 2009,

and waited more than 3 years to take the examination

(name)(he/she)