The new federal ban on surprises medical bills could have a “substantial” impact on radiology practices, including those that typically do not practice out-of-network balance billing.
That’s according to a new analysis penned by several experts in the field and published Tuesday in Radiology. Federal lawmakers took aim at this issue in December, with Health and Human Services beginning the rulemaking process July 1. Barring any unforeseen changes, the feds plan to ban the practice of sending surprise bills for out-of-network care by Jan. 1, 2022.
Experts anticipate the legislation could upend reimbursement rate negotiations between radiologists and insurers. Rulemaking that just launched last week will likely have a large role in determining the No Surprises Act’s impact on the specialty.
“The new law, based on arbitration, attempts to protect good-faith negotiations between physicians and insurance companies and encourages network contracting. Radiology practices, even those that are fully in network or that never practiced surprise billing, could nonetheless be affected,” radiologists Richard Heller III, MD, MBA, of Rad Partners; Richard Duszak, MD, with Emory University; and Greenville Health System’s Naveen Parti, MD, MBA, wrote July 2. “Physician and stakeholder advocacy has been and will continue to be crucial to the ongoing evolution of this process,” they added later.
Many agree about the need to protect patients from such surprise gaps in health insurance coverage, the authors noted. However, the second aspect of the legislation—impacting negotiations between payers and providers—is more complex. Imaging advocates have expressed concern that establishing set reimbursement levels in the law could disrupt negotiations and manipulate in-network rates. However, as currently construed, the law would utilize an independent arbitrator to settle disputes, as favored by rads, rather than the benchmarking approach championed by payers.
Heller et al. highlighted several concerns with the law that could be targeted through advocacy. In the absence of a state surprise billing law, for instance, insurers may be allowed to determine the initial payment, and some might use this as a chance to underpay. Timeline is also touchy, the authors noted, as previous versions of the bill would give radiologists only four days from the end of a 30-day negotiation period to formally request an independent-resolution process. Plus, there is a 90-day period after an determination where the rad is forbidden from requesting another IDR.
Along with advocacy, experts believe it will be important to track the No Surprises Act’s impact on practices, and the law does provide for several future reports to Congress.
“Some believe that the law could accelerate physician group consolidation because larger organizations, with the benefits of scale, may be better equipped to deal with its challenges,” Rad Partners Associate Chief Medical Officer Richard Heller and co-authors noted. “The alternative for many practices may be to accept a suboptimal rate to be in network, avoiding the costs and challenges of going [out of network] with a major insurer who is experienced in IDR.”
Read the rest of their review and commentary in the Radiological Society of North America’s flagship journal here.
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.