ACR asks radiologists to mobilize in support of 2 key payment-related legislative proposals
The American College of Radiology is urging the imaging community to mobilize in support of two key pay-related pieces of legislation proposed in Congress.
ACR is seeking support for both the Find it Early Act and the Enhanced Enforcement of Health Coverage Act. The former would require payers to cover supplemental breast imaging scans such as MRI and ultrasound, which patients often must cover out of pocket. Meanwhile, the latter would increase penalties for insurers that fail to pay physicians under landmark legislation to end surprise medical bills.
Under the No Surprises Act, independent third parties are tasked with mediating disputes over insurer payments to physicians outside their health plan coverage network. However, radiologists and other specialists have reported that many are outright refusing to issue the agreed-upon amount, with no government enforcement mechanism to punish them.
“An important aspect of the [No Surprises Act] requires timely payment to the winning party following the conclusion of the [independent dispute resolution] process,” ACR said in its call to action. “Insurers have largely ignored this provision of the NSA, and in some instances, payments to physicians have been extraordinarily delayed or even nonexistent. New bipartisan legislation has been introduced to address these challenges.”
Rep. Greg Murphy, MD, R-N.C., introduced the Enhanced Enforcement of Health Coverage Act on Sept. 13, joined by Reps. Raul Ruiz, MD, D-Calif., and John Joyce, MD, R-Pa., Kim Schrier, MD, D-Wash., and Jimmy Panetta, D-Calif. Murphy and colleagues' proposed their legislation after Medicare released data showing the agency had received over 16,000 complaints about the NSA. Top grievances against health plans included issuing late reimbursement after disputes were resolved and failure to conform with requirements to issue payment or denial notices within 30 days.
House Resolution 9572 would financially penalize insurers that fail to pay physicians within 1 month of the IDR process concluding. It also would create transparency in reporting requirements related to the No Surprises Act, among other changes.
“ACR members are encouraged to contact their representative today and urge them to cosponsor H.R. 9572 to ensure that the NSA is carried out as Congress intended and hold insurers accountable,” the college said in a Thursday news update.
Find it Early update
Meanwhile, ACR on Thursday also asked members to contact their U.S. representative and urge them to support the Find it Early Act.
House Reps. Rosa DeLauro, D-Conn., and Brian Fitzpatrick, R-Pa., reintroduced the bill in May 2023. A Senate version, supported by Sens. Amy Klobuchar, D-Minn., and Roger Marshall, MD, R-Kan., followed last month.
Find it Early would require private payers, along with traditional Medicare and Advantage plans, to cover supplemental scans needed by patients predisposed to the disease or with dense breasts. About 1 in 8 women are diagnosed with breast cancer, and 71% of these cases occur in individuals with dense breasts. However, imaging technologies such as MRI are often unavailable to patients because insurance does not cover them, necessitating high out-of-pocket expenses. Gaps in coverage can result in women paying over $1,000 for a breast MRI, according to the Susan G. Komen foundation.
Since Sept. 10, the Food and Drug Administration has required that mammography providers inform patients if they have dense breasts. However, inconsistent state regulations mean many women do not have coverage for the critical follow-up exams after a density alert. Absent nationwide congressional action, over 50% of states have passed their own patchwork of bills to help patients pay for cancer screenings.
“The Find It Early Act will close those gaps and ensure that private, public and military insurance programs, including TRICARE and [the Veterans Health Administration], cover essential imaging when medically necessary,” ACR said in its second Oct. 24 call to action. “Urge your member of Congress to co-sponsor H.R. 3086. Supporting this vital legislation will help ensure that women across the country have access to early and accurate detection and diagnosis of breast cancer, without additional financial barriers.”
Sens. Marshall and Klobuchar also promoted the bipartisan bill in a press announcement shared Oct. 3. Along with ACR, Find it Early is supported by the Radiology Business Management Association, Susan G. Komen; the Brem Foundation, Dense Breast-info, the American College of Surgeons, the American Cancer Society, My Density Matters and the Society of Nuclear Medicine and Molecular Imaging.
“This bill is a crucial step in ensuring that all women have access to the additional imaging they need for early detection of breast cancer, without the burden of extra costs,” Marshall, an OB-GYN specialist, said in a statement. “I am proud to help lead this bipartisan legislation that improves coverage of necessary follow-up care for women. This is a great first step that has the opportunity to change lives.”
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.