Radiology Partners the No. 1 initiator of No Surprises Act disputes with 136,784, CMS says

Radiology Partners was the No. 1 initiator of No Surprises Act payment disputes in the second half of 2024 with 136,784, according to new data released Wednesday. 

The El Segundo, California-based industry giant accounted for about 15% of all disputes in Q4 of 2024 and 18% in Q3. HaloMD, a San Antonio, Texas, firm specializing in NSA dispute resolutions, was No. 2, initiating 134,318, followed by Knoxville, Tennessee, multispecialty group TeamHealth with 94,598. 

In a summary document, the Centers for Medicare & Medicaid Services highlighted the “high volume of disputes” handled between July 1 and Dec. 31, 2024. Provider groups such as Rad Partners initiated a total of 853,374 disputes through the federal independent dispute resolution (IDR) portal, up 40% from the first half of 2024. Across all of last year, a small number of organizations were responsible for the majority of disputes, CMS noted.

“Many of the top initiating parties are (or are represented by) large practice management companies, medical practices or revenue cycle management companies representing hundreds of individual practices, providers or facilities,” the agency said May 28. “The top three initiating parties (Radiology Partners, HaloMD, and TeamHealth) represent thousands of clinicians across multiple states and accounted for approximately 43% of all disputes initiated in the last six months of 2024.”

Congress enacted the No Surprises Act in 2020, and it took effect on Jan. 1, 2022, seeking to protect patients from surprise medical bills. Under the NSA, independent arbitrators are tasked with mediating disputes between commercial health insurers and healthcare providers that are out of their coverage networks. On the payer side, the country’s largest commercial insurer, UnitedHealthcare, was involved in the most disputes at 242,711. Aetna was the next closest with 120,943, followed by MultiPlan at 96,787, and Blue Cross and Blue Shield of Texas with 96,560. 

Independent payment dispute arbitrators rendered determinations in 698,968 (82%) of disputes in the second half of 2024, CMS reported. Emergency department services made up the greatest share at 40%, followed by radiology at 20%. Providers were the prevailing party in about 85% of instances, while health plans and issuers won in the other 15%. 

Rad Partners could not provide comment on the new IDR data as of late Thursday. However, the practice shared a statement in March after CMS released NSA information for the first half of 2024, when RP also was No. 1, initiating 110,000 payment disputes. 

“It is concerning that some insurers continue to misuse the well-intentioned No Suprises Act,” a representative told Radiology Business at the time. “By keeping many hospital-based practices out of network, under-reimbursing for care and frequently failing to negotiate prior to IDR, these insurers are negatively impacting medical practices’ ability to operate and their patients’ access to care as well as driving the volume of IDR disputes. Further, even when providers prevail in IDR, insurers frequently do not pay on time (or at all). Hopefully, future legislative and regulatory actions will address these issues and strengthen the law’s protections of patients and providers.”

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, after it kicked an affiliated practice out of network, the radiology group improperly flooded the system with tens of thousands of disputes. Rad Partners—which is backed by Whistler Capital Partners and New Enterprise Associates—responded in February, noting it has won 98% of disagreements with Aetna, believing the payer is trying to push around providers to pad profits. 

Healthcare policy expert Ed Gaines, with Zotec Partners, shared the data on social media Thursday. He noted that radiology’s average prevailing offer was about 535% of the “qualifying payment amount”—essentially, the median contracted rate for a service in the same geographic region. For anesthesia services, the figure was 280%, while it was 277% for emergency medicine. 

Ned Holman, MD, an Alaska-based radiologist who previously worked for RP, criticized the practice’s use of the IDR process on Thursday. 

“535% of the [qualifying payment amount] is far too high for radiology and is evidence that the IDR process is being exploited by private equity to drive up costs for healthcare insurers, which ultimately translates to higher premiums for patients,” he wrote in response to Gaines’ original message. 

Updated on May 30: Rad Partners shared a statement Friday in response to the new CMS data: 

"We believe that in-network contracting is in the best interest of both patients and physicians. Unfortunately, the PUF data indicates that some insurers remain unwilling to contract reasonably with hospital-based practices. As to why they may be uninterested in network contracting, and in the spirit of transparency and access to care, we encourage Congress to examine the issue of so-called 'shared savings' more closely, as the financial incentive for insurers to remain out of network is evident. 

Until then, we are grateful for the neutral arbiters that recognize the inappropriate gamesmanship of some insurers and overwhelmingly side with our doctors in payment disputes."