Radiology groups see mixed bag in feds’ proposal to fix the No Surprises Act

Radiology groups are expressing mixed feelings about a recent proposal to modify the independent dispute-resolution process under the No Surprises Act.

In October, the Biden Administration issued a proposed rule in response to criticism from radiology and other specialties around the landmark law. Among various changes, the update seeks to improve communication between health insurers, physicians and the independent entities that arbitrate disagreements over out-of-network payments. It also would adjust timelines for the independent dispute resolution process, along with establishing new criteria for “batching” together similar requests.

Both the Radiology Business Management Association and American College of Radiology recently weighed in on the proposal, coinciding with the deadline to submit public comments. In a Jan. 4 news update, ACR said it supports many of the changes but is concerned about the lack of punishment if payers do not follow the rules.

“The ACR appreciates the departments’ [of Labor, Treasury and HHS] acknowledgement of many concerns we have raised in previous comment letters and the proposals to address these concerns,” CEO William T. Thorwarth Jr., MD, wrote in his comment letter. “While these are a step in the right direction, if there is not meaningful enforcement of these regulations, there is limited efficiency of rulemaking. We strongly urge the departments to establish and enforce penalties for noncompliance with these regulations. We also urge the departments to work to end the cycle of IDR submissions by correcting the incentives for insurers to under-reimburse providers.”

In a separate comment letter, RBMA highlighted the importance of being able to batch together similar claims. Hospital-based radiology services often involve relatively small payment amounts and high volumes of a single CPT code. A typical radiology group can “easily” submit thousands of X-ray claims to a major payer in one month.

“It is critical to radiologists that the batch method be preserved in a form that is viable for both providers and the independent dispute resolution entity,” RBMA Executive Director Bob Still wrote Jan. 2.

He noted that the current IDR portal setup is “extremely cumbersome to use for batch disputes on a scale that is viable for radiology groups.” Manual entry of individual claims is “generally not practical,” he added, and a requirement to upload copies of explanations of benefits, or remittance advices, is “exceedingly cumbersome.” This requires extracting individual claim data from multiple bulk remittances and then manually downloading data from the websites of health plans or issuers.

The administration is proposing to limit batches to 25 services, a move both groups want changed.

“This limitation would largely make the dispute resolution process economically off limits to radiologists,” Still wrote.

You can read much more in the full comment letter from RBMA here and find ACR’s full comment letter here.