Radiology Associates of North Texas says it will waste over $51M on costs related to No Surprises Act

Radiology Associates of North Texas projects it will waste over $51 million on administrative costs related to legislation aimed at addressing surprise medical billing. 

The country’s largest independent imaging group—based in Fort Worth and employing nearly 300 physicians—calculated the figure based on an internal analysis of its billing practices. 

RANT said it’s also owed millions from health insurers who lost disputes over payment and now refuse to cut a check. The radiology practice is calling for federal action, including passing legislation that penalizes insurers such as Blue Cross Blue Shield of Texas for failing to issue prompt payment. 

“When arbitration awards can go unpaid without meaningful consequences, the dispute process loses credibility and costs continue to rise across the system,” Kurt Schoppe, MD, president of Radiology Associates of North Texas, said in a statement May 19. 

Under the No Surprises Act, enacted by Congress in 2020, physicians and payers can settle disputes over out-of-network healthcare services. This is meant to protect patients from unexpected bills, which proponents say the NSA is achieving. Radiologists and other docs are reportedly winning in the “independent dispute resolution,” or IDR, process at a high clip. The law allows these outside arbitrators to issue binding decisions for imaging and other services, but health insurers are now refusing to pay up afterward. 

Radiology Associates estimates it has prevailed in about 95% of finalized IDR disputes with Blue Cross Blue Shield of Texas, the state’s largest insurer. However, more than $3.5 million in awarded balances remain unpaid. RANT estimated that $1.64 million of this total has been outstanding for over 120 days. As of Tuesday, BCBS Texas has paid approximately 2% of awarded balances. 

RANT also expressed concern about restrictions around how radiology practices can batch together claims to be submitted to the IDR process. Current rules force the practice to divide similar claims into thousands of smaller arbitration filings, each carrying separate filing and IDR fees. Under current federal interpretation of the law advocated for by BCBS of Texas, Radiology Associates says it will file over 68,000 payment batches, with total administrative cost of nearly $53 million. Under an ideal process, RANT estimated it would have submitted 1,369 batches for a total administrative tally of $1.05 million. 

Costs stem from federally mandated fees both radiologists and insurers must pay. They include a $115 administrative fee per batch and another $655 arbitrator fee per batch. For a typical radiology claim that averages $110, these administrative costs can greatly exceed the underlying medical service “many times over,” RANT said. 

“These are avoidable costs being forced into the healthcare system,” Schoppe said. “Ultimately, those expenses flow back to employers and plan sponsors through higher administrative overhead and increased healthcare costs.”

This issue has escalated in urgency after the Fifth Circuit Court recently ruled that radiologists and other providers do not have a private right of action to enforce unpaid IDR awards. RANT said it is calling on lawmakers to adopt reforms necessary to preserve the intent of the No Surprises Act and reduce “unnecessary administrative waste.” It's asking for passage of federal legislation that would penalize payers for failing to issue reimbursement in a timely fashion. The practice also is advocating for modernization of batching guidance from the Centers for Medicare & Medicaid Services. This will allow radiologists to resolve disputes more efficiently without added administrative costs. 

RANT noted that this issue extends well beyond Texas and the practice’s quarrel with the local BCBS affiliate. 

“We support the goals of the No Surprises Act. Patients should be protected,” Schoppe concluded. “This is about restoring common sense to a system that is creating preventable administrative waste. The law works only if all parties are required to follow the rules.”

Leaders with RANT, Radiology Partners and Zotec Partners also spoke about challenges with the No Surprises Act at the Radiology Business Management Association’s annual meeting last month in Orlando. Separately, BCBS Texas previously sued Zotec in December, claiming the billing company abused NSA processes to obtain higher payments for out-of-network providers. Zotec has sought to dismiss the complaint, calling it a “collateral attack on a federal dispute resolution program Congress designed to be fast, final, and largely insulated from judicial review,” according to court records. 

Meanwhile, the American College of Radiology, American Society of Neuroradiology, all 50 state medical societies and others recently urged Congress to pass the same legislation RANT is asking for.