Radiology accounts for 16% of No Surprises Acts payment disputes, new data show
Radiology accounts for about 16% of payment disputes under the No Surprises Act, according to new data from the federal government.
The specialty came in second on the list behind emergency medicine, which made up about 48% of such quarrels, the Centers for Medicare & Medicaid Services reported March 18. Imaging industry giant Rad Partners led the way, initiating 110,000 payment disputes in the first half of 2024.
The American College of Radiology highlighted the data in a news update published Thursday.
“Providers won in approximately 84% of cases, which indicates a pattern of payers undervaluing the care provided to patients,” ACR reported March 27.
Congress enacted the landmark law in 2020, and it took effect on Jan. 1, 2022, seeking to protect patients from surprise medical bills. Under the No Surprises Act, independent arbitrators are tasked with mediating disputes between commercial health insurers and healthcare providers that are out of their coverage networks.
UnitedHealthcare, the country’s largest health insurer, accounted for the most initiated disputes with 178,327 in the first six months of 2024. Aetna came in second with 93,400 followed by MultiPlan (68,559). On the provider side, Rad Partners was No. 1, initiating about 22% of disputes in Q1 of last year and 15% in Q2. Emergency medicine and hospital care provider SCP Health came in at No. 2 with 82,611 initiated payment disputes, while multispecialty group TeamHealth accounted for 73,900. Envision Healthcare, which provides radiology and other specialty services, also made the list, initiating 22,805 or 4% of disputes.
Overall, the number of IDR disputes decreased in the first half of 2024 when compared to the previous six months in 2023. The tally fell from about 22% in 2023 down to 18% in 2024, “which reflects process improvements and greater familiarity with eligibility requirements,” ACR noted.
“The departments are committed to helping certified IDR entities and disputing parties obtain resolution on disputes as expeditiously as possible and to promoting efficiency and transparency in the federal IDR process,” the feds said in a summary document.
Radiology Partners’ use of the IDR process is the subject of an ongoing court battle with Aetna. The Hartford, Connecticut-based payer sued RP in December, claiming that, after it kicked an affiliated practice out of network, the radiology group improperly flooded the system with tens of thousands of disputes. Los Angeles-headquartered, private equity-backed Rad Partners fired back in February, noting that it has won 98% of its disagreements with Aetna, with the payer trying to push around providers to pad profits.
“Aetna’s strategy includes terminating physician contracts, exploiting the system and avoiding payments—even when those payments are binding and ordered by a neutral, federally approved arbiter,” CEO Rich Whitney, MBA, said last month. “These tactics harm patients, contribute to the national physician shortage and waste healthcare resources, including driving up costs for Aetna’s own self-funded employer plans.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.