Radiology groups urge Congress to enact penalties against payers who violate No Surprises Act

Radiologists and other physician specialists are urging Congress to pass bipartisan legislation that would punish payers who violate the No Surprises Act. 

The American College of Radiology, American Society of Neuroradiology, all 50 state medical societies and numerous others wrote to members of the U.S. House and Senate to express their frustrations on Monday. They’re asking lawmakers to pass the No Surprises Act Enforcement Act, urging for “prompt action on this important legislation.” 

First introduced by Rep. Greg Murphy, MD, R-N.C., and others in September 2024, the legislation would close enforcement gaps under the landmark legislation, increasing penalties for refusing to issue payment after losing a dispute. Sens. Roger Marshall, MD, R-Kan., and Michael Bennet, D-Colo., also introduced companion legislation in the Senate in December 2024. 

“Stakeholders continue to raise concerns about implementation challenges related to the independent dispute resolution process,” ACR, ASNR and others wrote on May 11. “We are committed to working with regulators to increase transparency, strengthen enforcement and enhance guidance to improve the process,” they added.

The No Surprises Act utilizes independent arbitrators to help settle disputes between physicians and insurers over out-of-network care. Docs have reportedly been winning these disagreements at a high rate, with payers often refusing to issue reimbursement after losing. Insurers, meanwhile, have complained of problems such as ineligible claims making their way into the dispute-resolution process. ACR et al. acknowledged this challenge, saying they support proposals to clearly identify eligibility as part of the first payment offer. Doc groups also are calling for changes to help reduce over reliance on the IDR process, such as mandatory participation in open negotiations prior to arbitration. 

“However, process improvement efforts are rendered meaningless if IDR decisions are simply ignored by the losing parties, as incentives for disputing parties to meaningfully engage are lost,” the groups wrote. “Unfortunately, physicians continue to report that health plans are failing to make payments within the statutory 30-day timeframe following an IDR determination in the physician’s favor.” 

In some cases, radiologists are receiving no payment at all, despite the law’s clear requirements, they added. This means radiology groups are being forced to absorb unpaid costs, finance delays, and “shoulder uncertainty while insurers retain funds they are legally obligated to pay.” The NSA Enforcement Act would solve these problems by increasing penalties for noncompliance with payment deadlines. It also would bolster transparency in reporting requirements, among other changes. 

“By granting the administration clear authority to enforce IDR decisions, the No Surprises Act Enforcement Act would restore the balance achieved by the statute and ensure accountability,” the doc groups added. “The success of the No Surprises Act depends on all parties participating in good faith and complying with the dispute resolution process.”

Others signing the letter included the American Medical Association, Medical Group Management Association, American College of Emergency Physicians, and American Society of Anesthesiologists. The latter two have frequently worked with ACR on NSA-related issues, with their specialties also impacted by surprise billing. Both the AMA and MGMA promoted the letter to their members in separate news updates published Monday. 

Along with Rep. Murphy and Sens. Marshall and Bennet, the letter also was addressed to other co-sponsors of the legislation in the House. They include Reps. Jimmy Panetta, D-Calif., John Joyce, MD, R-Pa., Kim Schrier, MD, D-Wash., Bob Onder, MD, R-Mo., and Raul Ruiz, MD, D-Calif. Physician societies wrote to the departments of Labor, Treasury and Health and Human Services in April, expressing some of the same concerns about the No Surprises Act.