Post on 14-Feb-2020
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: info@echoboards.org 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.
4
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.
5
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.
Please refer to page 10 for additional information.
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.
Please refer to page 10 for additional information.
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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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BOAR
D CE
RTIF
ICAT
ION
REQU
IREM
ENT
5 –
ADUL
T CA
RDIO
VASC
ULAR
DIS
EASE
TRA
ININ
G TI
ME
TABL
E
Sect
ion 1
Se
ction
2
Sect
ion 3
Le
vel o
f Cer
tifica
tion
Le
ss T
han
3 ye
ars
Traini
ng C
omple
ted
betw
een
Traini
ng C
omple
ted
Prior
to
Ap
plied
For
: ou
t of T
raini
ng
July,
1, 1
990
& Ju
ly 1,
2009
Ju
ly 1,
1990
Board Certification Requirements
Com
preh
ensiv
e (c
)R
equi
rem
ent 5
. The
app
lican
t mus
t hav
e co
mpl
eted
Lev
el I
I Tr
aini
ng (6
mon
ths
trai
n-in
g w
ith p
erfo
rman
ce o
f 15
0 an
d in
terp
reta
-tio
n of
300
tran
stho
raci
c ec
hoca
rdio
gram
s m
ust h
ave
perf
orm
ed a
nd in
terp
rete
d at
leas
t 50
tran
seso
phag
eal,
and
mus
t hav
e pa
rtic
i-pa
ted
in a
nd in
terp
rete
d 10
0 st
ress
ech
ocar
-di
ogra
ms
durin
g tr
aini
ng).
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 Tr
aini
ng D
irect
or o
r the
Med
ical
D
irect
or o
f th
e E
choc
ardi
ogra
phy
Lab
(Lev
el
III)
ver
ifyin
g co
mpl
etio
n of
Lev
el I
I Tr
ain-
ing,
the
date
s of
trai
ning
, and
the
num
ber
of tr
anst
hora
cic,
tran
seso
phag
eal,
and
stre
ss
echo
es p
erfo
rmed
dur
ing
trai
ning
. The
lette
r m
ust i
nclu
de a
sta
tem
ent f
rom
the
Trai
ning
D
irect
or in
dica
ting
that
the
appl
ican
t has
the
clinicalcompetenceandprofessionalquali-
ties
nece
ssar
y to
per
form
as
an in
depe
nden
t ec
hoca
rdio
grap
her.
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
ovid
ed e
choc
ardi
ogra
phy
serv
ices
of
at le
ast
4002-DimensionalEcho/Dopplerstudies,
50 tr
anse
soph
agea
l, an
d 10
0 st
ress
ech
ocar
-di
ogra
ms
per y
ear f
or e
ach
of tw
o (2
) yea
rs
imm
edia
tely
pre
cedi
ng th
is a
pplic
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 verifyingthenumberof2-DEcho/Doppler
stud
ies,
tran
seso
phag
eal,
and
stre
ss e
choc
ar-
diog
ram
s pe
rfor
med
.
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/Dopplerstudies
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 5
0 tr
ans-
esop
hage
al a
nd 1
00 s
tres
s ec
hoca
rdio
gram
s pe
r yea
r for
eac
h of
two
(2) y
ears
imm
edia
tely
pr
eced
ing
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 verifyingthenumberof2-DEcho/Doppler
stud
ies,
tran
seso
phag
eal,
and
stre
ss e
choc
ar-
diog
ram
s pe
rfor
med
.
Trans
thor
acic
Ce
rtific
ation
(t)
Req
uire
men
t 5. T
he a
pplic
ant m
ust h
ave
Leve
l II
Trai
ning
(6 m
onth
s tr
aini
ng w
ith
perf
orm
ance
of
150
and
inte
rpre
tatio
n of
300
tr
anst
hora
cic
echo
card
iogr
ams)
.
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 Tr
aini
ng D
irect
or o
r the
Med
ical
D
irect
or o
f th
e E
choc
ardi
ogra
phy
Lab
(Lev
el
III)
ver
ifyin
g co
mpl
etio
n of
Lev
el I
I Tr
ain-
ing
and
the
num
ber o
f tr
anst
hora
cic
stud
ies
perf
orm
ed d
urin
g tr
aini
ng. T
he le
tter m
ust i
n-cl
ude
a st
atem
ent f
rom
the
Trai
ning
Dire
ctor
in
dica
ting
that
the
appl
ican
t has
the
clin
ical
andprofessionalqualitiesnecessarytoper
-fo
rm a
s an
inde
pend
ent e
choc
ardi
ogra
pher
.
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
ovid
ed e
choc
ardi
ogra
phy
serv
ice
of a
t lea
st
4002-DimensionalEcho/Dopplerstudiesper
year
for e
ach
of th
e tw
o (2
) yea
rs im
med
iate
ly
prec
edin
g th
is a
pplic
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
ri-fyingthenumberof2-DimensionalEcho/
Dop
pler
stu
dies
per
form
ed p
er y
ear f
or e
ach
of th
e tw
o (2
) yea
rs p
rece
ding
the
appl
icat
ion.
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/Dopplerstudies
per y
ear f
or e
ach
of th
ree
year
s pr
eced
ing
the
appl
icat
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
rifyi
ng th
e nu
mbe
r of
Tran
stho
raci
c st
udie
s pe
rfor
med
per
yea
r for
eac
h of
thre
e (3
) yea
rs
prec
edin
g th
e ap
plic
atio
n.
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.
Trans
esop
hage
al E
choc
ardio
grap
hy
(Inclu
des t
he
Follo
wing
Two)
:
Trans
thor
acic
and
Trans
esop
hage
al Ec
hoca
rdiog
raph
y Ce
rtific
ation
(te)
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.
9
Board Certification Requirements
Trans
esop
hage
al E
choc
ardio
grap
hy
(Inclu
des t
he
Follo
wing
Two)
:
Trans
thor
acic
and
Trans
esop
hage
al Ec
hoca
rdiog
raph
y Ce
rtific
ation
(te)
Req
uire
men
t 5. T
he a
pplic
ant m
ust h
ave
com
plet
ed L
evel
II T
rain
ing
(6 m
onth
s with
the
perf
orm
ance
of
150
and
inte
rpre
tatio
ns o
f 30
0 tr
anst
hora
cic
echo
card
iogr
ams)
and
per
for-
man
ces a
nd in
terp
reta
tions
of
at le
ast 5
0 tr
ans-
esop
hage
al e
choc
ardi
ogra
ms d
urin
g tr
aini
ng.
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
the
Trai
ning
Dire
ctor
or t
he M
edic
al D
irect
or
of th
e ec
hoca
rdio
grap
hy la
b (L
evel
III
) ver
ify-
ing
the
com
plet
ion
of L
evel
II
Trai
ning
, the
da
te o
f tr
aini
ng, a
nd th
e nu
mbe
r of
tran
stho
-ra
cic
and
tran
seso
phag
eal s
tudi
es p
erfo
rmed
du
ring
trai
ning
. Thi
s le
tter m
ust i
nclu
de a
st
atem
ent f
rom
the
Trai
ning
Dire
ctor
indi
cat-
ing
that
the
appl
ican
t has
the
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
rifyi
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.
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 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
o-ca
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
prop
riate
lette
rhea
d fr
om th
e Tr
aini
ng D
irect
or o
r the
Med
ical
D
irect
or o
f th
e E
choc
ardi
ogra
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
t 4002-DimensionalEcho/Dopplerstudies
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.
Board Certification Requirements
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.
Requirement 2 for Transthoracic (t) Certification:
Acurrentlicenseorequivalentdocumentationof permissiontopracticemedicine in the country of principal residence.
Requirement 3 Transthoracic (t) Certification:
Documentationof specialtyboardcertificationoritsequivalent.
Requirement 4 for Transthoracic (t) Certification:
Documentation of 24 months of training dedicated to adult cardiovascu-lar disease.
Requirement 5 for Transthoracic (t) Certification:
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.
Requirement 6 for Transthoracic (t) Certification:
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.
Please refer to page 10 for additional information.
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
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
To Whom It May Concern:
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)
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 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
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
To Whom It May Concern:
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)**
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 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)