IAC Accreditation Checklist
for Vein Center
®
VASCULAR TESTING . ECHOCARDIOGRAPHY . NUCLEAR/PET . MRI . CT
DENTAL CT . CAROTID STENTING . VEIN CENTER . CARDIAC ELECTROPHYSIOLOGY
800.838.2110 | intersocietal.org
IAC Vein Center Accreditation Checklist - Updated July 2016
©2016 Intersocietal Accreditation Commission. All Rights Reserved.
i
IAC Accreditation Checklist for Vein Center
Use the following checklist as a guide when preparing your application for vein center accreditation or reaccreditation.
P
Step 1: Before You Begin
Read and Review the IAC Standards for Vein Center
Accreditation: Superficial Venous Evaluation and Management
The Standards are the basis for the accreditation program;
defining the minimum requirements for all vein centers to
provide high quality patient care. It is imperative to read and
understand the Standards. Always follow the most current
version of the Standards, which are posted on the website at:
intersocietal.org/vein/seeking/vein_standards.htm
Perform a Thorough Facility Self-Assessment
Prior to completing the application, facilities should review
their current policies and Quality Improvement (QI) Program
and identify areas that currently are not in compliance with
the Standards.
IAC Accreditation Agreement
It is important to have the appropriate personnel at your
facility review the IAC Agreement and decide if changes
need to be made prior to application submission.
Explore the Website
There are many helpful tools on the website:
• If making modifications to the IAC Agreement: Be
sure to have the agreement filled out completely and
signed in all areas (by an authorized representative).
Applications submitted to the IAC must be accompanied
by a completed IAC Accreditation Agreement (current
published version) in order to receive an accreditation
decision.
 Sample Documents – checklists, sample policies and
guidance documents. intersocietal.org/vein/seeking/
sample_documents.htm
 On Demand Webcasts – learn about accreditation at your
leisure, 24 hours a day/7 days a week, for free.
intersocietal.org/vein/main/on_demand.htm
• If no modifications are required: The facility can
electronically complete and sign the unmodified
Agreement provided at the end of the IAC Online
Accreditation application. Read and follow all prompts
in the ‘Accreditation Agreement’ portion of the online
application when utilizing this option.
 Frequently Asked Questions – find answers to commonly
asked questions. intersocietal.org/vein/main/faq.htm
 Links and References – a variety of online resources from
vein center-related organizations, journals.
intersocietal.org/vein/main/links_references.htm
 CME Resources – A list of resources for Continuing Medical
Education (CME) both live and online. intersocietal.org/
vein/main/cme_resources.htm
For the complete instructions, please review “Legal, IAC
Agreement” at intersocietal.org/iac/legal/agreement.htm.
P
Step 2: Gather Information
All facilities are required to include the items listed below as part of the
Online Accreditation application prior to hitting the submit button online:
First-Time Applicants:
 Facility Procedure Log – The vein center must submit a log
of all patients seen in the vein center for evaluation and/or
management. The data for this log can come from appointment
scheduling reports or compiled into our sample logs. To access
a sample of the log, visit intersocietal.org/vein/seeking/
sample_documents.htm.
The information in the log MUST include the following: patient
id, patient date of birth and date and type of procedure (cpt/
hcpcs codes are acceptable). All medical staff members,
nursing staff members and physician extenders who perform
procedures must be represented in the log. Submit as many
additional months’ logs as needed to represent all staff. Preand post-procedure patient assessment, outcomes of the
procedure and complications are optional.
• If total procedure volume is 100 or greater per month –
submit the procedure log from the previous two months
•




If total procedure volume is less than 100 per month –
submit the procedure logs from the previous three months
Staff Information – Enter only staff members who perform the
following procedures in the online application: sclerotherapy,
ambulatory phlebectomy, saphenous vein ablation and
management of chronic venous insufficiency (wound care) and
complete questionnaire.
Protocols (All procedures that are performed outlining what is
done pre, during and post-procedure):
• Sclerotherapy
• Ambulatory Phlebectomy
• Endovenous Thermal Ablation
• Management of Chronic Venous Insufficiency (wound care)
Quality Improvement Policy – A written policy regarding QI
initiatives must be uploaded to the application.
Physicist Report (if fluoroscopy performed) - A physicist report
must be attached for all pieces of equipment used for the
purposes of fluoroscopy.
[CONTINUED ON NEXT PAGE ...]
IAC Vein Center Accreditation Checklist - Updated July 2016
2
P
Step 2: Gather Information (cont.)
Reaccreditation Applicants:
 Staff Information – Enter or update CURRENT staff members
as needed who perform the following procedures in the online
application: sclerotherapy, ambulatory phlebectomy, saphenous
vein ablation and Management of Chronic Venous Insufficiency
(wound care) and complete the questionnaire.
 Protocols (All procedures that are performed outlining what is
done pre, during and post-procedure):
• Sclerotherapy
• Ambulatory Phlebectomy
P
• Endovenous Thermal Ablation
• Management of Chronic Venous Insufficiency (wound care)
 Quality Improvement Policy – Review your facility’s current QI
Policy.
 Physicist Report (if fluoroscopy performed) - A physicist report
must be attached for all pieces of equipment used for the
purposes of fluoroscopy.
Other documentation MUST BE KEPT ON FILE for review at the time
of the site visit. For a complete list of what will be reviewed during
the site visit, download the Site Visit Checklist»
Step 3: Complete Online Application
Work on your application for accreditation using the IAC Online
Accreditation access:
 Access to IAC Online Accreditation is available for use by vein
centers when applying for accreditation.
 Facilities need to complete the questionnaire and upload
the requested documentation when applying for first-time
P
accreditation or reaccreditation.
 The technical protocols for procedures performed, the physicist
report(s) (if fluoroscopy is used) and the facility procedure log,
must be uploaded in the application.
To learn more about using Online Accreditation, please visit
intersocietal.org/vein/seeking/about_accreditation.htm.
Step 4: Submitting the Application
 Once you have completed the appropriate sections of the
Account Profile, the accreditation questionnaire and required
uploads, you will submit your facility’s application using the
submit button indicated. Once you click the submit button, the
data becomes your final application.
submit the selected case study documentation (as listed in the
case study checklist), IAC Accreditation Agreement (if modified)
and fee (if paid by check).
 A read-only copy of your application is accessible by using
the Applications link. Changes may be made to the Account
Profile (equipment, site and staff information, including e-mail
addresses) continuously between accreditation cycles to
simplify the reaccreditation process.
 Reaccreditation Applicants: Case study information must be
entered into the online application questionnaire and, upon
questionnaire submission, required case study supporting
documentation (as listed in the case study checklist) must
be mailed to the IAC. Facilities will have 30 days to submit
the selected case study documentation, IAC Accreditation
Agreement (if modified) and fee (if paid by check).
 First-Time Applicants - The Medical Director(s) identified in the
application will be notified within 10 days that the application
and log were received and which procedures have been
selected for submission. Facilities will then have 30 days to
 The requested documentation must be submitted via a
traceable carrier (i.e., UPS, FedEx) and will not be accepted
via e-mail or fax. Mail your materials to IAC Vein Center, 6021
University Blvd., Suite 500, Ellicott City, MD 21043.
P
Step 5: Case Study Submission
Case Study Selection
First-Time Applicants: Once you hit submit on your IAC Online
Accreditation application, three random venous treatment cases will be
chosen from the submitted procedure log for review; one of those cases
will be designated to include the complete diagnostic peripheral venous
duplex case study including images, worksheets and the final report. The
Medical Director(s) identified in the application will be notified within 10
days that the application and log were received and which procedures
have been selected for submission. Facilities will then have 30 days to
submit the selected case study documentation (as listed in the case
study checklist).
Reaccreditation Applicants: Three ablation (non-thermal, LASER and/
or RFA) procedures of your choice must be entered into the application
questionnaire and must represent as many staff as possible. Once the
IAC Online Accreditation application questionnaire is submitted, facilities
will then have 30 days to submit the required case study documentation
(as listed in the case study checklist).
[CONTINUED ON NEXT PAGE ...]
IAC Vein Center Accreditation Checklist - Updated July 2016
3
P
Step 5: Case Study Submission (cont.)
Case Study Supporting Documentation
Procedure Documentation:
Once your facility has been notified by the IAC of which three
procedures have been selected (first-time applicants), or once
your reaccreditation application has been submitted with your
three entered cases; send the requested case studies and
supporting documentation within 30 days to the IAC office via a
traceable carrier (i.e., UPS, FedEx). It is required that all case study
information be collected and sent in a single shipment. Mail to:
IAC Vein Center, 6021 University Blvd., Suite 500, Ellicott City, MD
21043.
 Procedure, limb and vessel-specific informed consent
Submit the following required documentation for each submitted
case study. Please do not anonymize any of the documentation.
Pre-Procedure Documentation:
 Complete patient history and physical exam documentation,
including, but not limited to:
• History of venous disorders
• Past medical history
• Family history
• Current medications
• Allergies
• Appropriate clinical indication for the procedure
 Noninvasive diagnostic functional reflux ultrasound final report
and worksheets
 In the case request e-mail, we will designate one case that must
include diagnostic images in addition to the final report and
worksheets. (Please note: Diagnostic images only required for
initial application)
 VCSS score (bilateral)
 CEAP (bilateral)
 Pre-treatment photographs
 Treatment plan
P
 Complete venous procedure summary, including but not limited to:
• Documentation of correct patient, site and procedure
• Anesthesia record
• Concentration/amount of tumescent infused
• Local anesthetic (if used)
• Treatment site
• Start/end time of procedure
• Length of vessel treated
• Catheter insertion site
• Energy deposited
• Number of stabs (AP)
• Complications or lack thereof
• Patient status post-procedure
Post-Procedure Documentation:
 Discharge instructions including:
• Dressing management including compression therapy
• Medications
• Follow-up appointments
Follow-Up Documentation:
 Follow-up clinical notes, including any patient satisfaction
comments
 Follow-up diagnostic ultrasound report
The Case Study Checklist MUST accompany each procedure as
well as the documentation requested. To access the Case Study
Checklist, please visit intersocietal.org/vein/seeking/sample_
documents.htm.
Step 6: After You Submit
Upon an application’s submission to the IAC office, it is imported into
the IAC database. The review process generally takes approximately
8 to 12 weeks to complete and the decision returned to the facility.
For complete details on application review and decisions, please refer
to the IAC Accreditation Program Policies & Procedures at
intersocietal.org/iac/legal/policies.htm.
NOTES
IAC Vein Center Accreditation Checklist - Updated July 2016
4