ACR rallies support for bill to punish payers who fail to pony up under No Surprises Act
The American College of Radiology is seeking to rally support for proposed legislation that would punish payers for failing to pony up after losing disagreements over reimbursement.
Bipartisan lawmakers previously introduced the No Surprises Act Enforcement Act last summer. Co-sponsors note that the landmark surprise-billing legislation was signed into law in 2020, aiming to settle disputes between insurers and physicians while protecting patients from receiving unexpected medical bills.
The legislation does so through an “independent dispute resolution” process, tasking an outside party with arbitrating arguments. However, providers have reported problems with insurers refusing to pay following rulings. This bill would aim to close enforcement gaps by increasing penalties for not complying with payment deadlines.
ACR on Feb. 12 encouraged its members to take action to get more members of Congress to support the bill.
“Insurance companies are exploiting loopholes in the law, ignoring payment determinations and endangering the stability of physician practices,” ACR said in its advocacy action alert. “As a radiologist and a constituent, your perspective is vital. Help us protect the viability of physician practices and the integrity of the patient-billing process.”
Rep. Greg Murphy, MD, R-N.C., is leading the effort in the U.S. House, joined by Reps. Jimmy Panetta, D-Calif., John Joyce, MD, R-Pa., Bob Onder, MD, R-Mo., and Kim Schrier, MD, D-Wash. Meanwhile, Sens. Roger Marshall, MD, R-Kan., and Michael Bennet, D-Col., are co-sponsoring companion legislation in the Senate.
The bill would fine insurers that fail to pay radiologists and other physicians within 30 days of resolving a dispute, ACR notes. It also would bolster transparency and accountability for payers shirking the law’s rules. The college has previously advocated for these changes alongside the American College of Emergency Physicians and American Society of Anesthesiologists, whose members also are disproportionately impacted by the surprise billing.
Recently released data from the Centers for Medicare & Medicaid Services show that emergency department services accounted for the greatest share of payment determinations under the No Surprises Act at 45%. Radiology was second at 19%, with industry giant Rad Partners a heavy user of the process.
One recent study showed that commercial insurers appear to be fudging payment estimates for radiology and other services under the NSA. The “benchmark” qualifying payment amount payers calculate often dramatically understates the actual median in-network rates insurers are paying for in-network care, researchers charge.
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.