American College of Radiology ‘disappointed’ with surprise-billing act’s payment methodology

The American College of Radiology said it is “disappointed” with how the feds plan to calculate qualifying payments under newly unveiled rulemaking to address surprise medical bills.

Health and Human Services just recently released its 411-page new rule, beginning the process of addressing this issue after Congress passed legislation in December. In determining whether provider payments qualify under the rule, the college is concerned the rule lacks nuance in how it addresses different provider groups.

“The ACR is disappointed with some aspects of the [qualifying payment amount] calculation methodology, including the treatment of each provider contract equally regardless of the practice size and market share of the providers when determining the median rate,” it said in a July 8 news update. “For example, the contracted rate of a practice with 25 radiologists serving 80% of the market is treated the same as contracts with three radiologists serving 5% of the market,” ACR added, arguing that incentive-based payments should also factor into the calculation of median rates.

Back in May, the ACR asserted its support for the No Surprises Act and its drive to keep patients out of reimbursement disputes. However, the group also underlined the need to fix holes in the legislation and ensure adequate reimbursement for out-of-network services. In a recent analysis, prominent radiologists said the No Surprises Act could potentially have a substantial impact on radiology practices, including those that do not practice out-of-network balance billing.

ACR also issued a detailed summary of the interim final rule on July 8 and said it will submit comments to Health and Human Services by the Sept. 7 deadline. The feds plan to implement the legislation on or after Jan. 1, 2022.