American College of Radiology ‘concerned’ about new fee under No Surprises Act

The American College of Radiology expressed concern Wednesday about a new fee from the feds under the No Surprises Act.

The charge commercial insurers and providers must pay to initiate the dispute-resolution process under the NSA will more than double next year, from $50 to $115, CMS announced Monday. This came following a lawsuit filed by the Texas Medical Association and others earlier this year, challenging a previous 600% increase, hiking the charge from $50 to $350. TMA et al. ended up prevailing in court, with a federal judge striking down the new amount. Radiology advocates at the time hailed the ruling as a “significant victory” for the specialty.

After the ruling, the feds dropped the fee back down to $50. But it’s increasing again in 2024, a move that will likely impact radiology more than other specialties.

“The ACR remains concerned about access to [independent dispute resolution] for radiology as most imaging claims are less than the finalized administrative fee of $115,” the college said in a Dec. 20 news update.

ACR noted that the new fee will take effect 30 days after publication of the rule in the Federal Register, so likely sometime in January. The administration said earlier this week that the administrative fee is meant to cover the expected cost of operating the federal IDR process. In a separate rule, the administration has proposed expanding batching guidelines, along with a policy to allow a reduced administrative fee for low-dollar claims, ACR noted. This rule remains in its comment period, with the college planning to submit feedback before the Jan. 2 deadline.

The American Society of Anesthesiologists issued its own breakdown of the announcement on Dec. 20. It expressed concerns around the fees that certified IDR entities can charge for single and batched determinations, which are both increasing significantly in 2024.