Radiology business leaders are urging the federal government to delay the launch date for legislation banning providers from sending “surprise” medical bills—set to start in less than four months.
Health and Human Services released its interim final rule in July, beginning the process of implementing the No Surprises Act created through congressional action. Tuesday was the final deadline for radiologists to submit comments on the legislation, with several groups in the imaging industry voicing their concerns.
The Radiology Business Management Association is pressing the administration to push back the go-live date for physicians to 2023. Health plans do not have the same launch period, and the Fairfax, Virginia-based advocacy group is concerned this could create patient confusion and an uneven playing field.
“With the continuing pandemic emergency, the effective date should be January 1, 2023,” Executive Director Robert Still wrote in comments submitted to the secretaries of HHS and the departments of treasury and labor on Sept. 2. “We don’t believe there is adequate time for providers or health plans to develop and put the necessary systems and procedures in place to comply with the rules by January 1, 2022, especially since some pertinent regulations have not yet been issued.”
Both RBMA and the American College of Radiology also criticized how the administration plans to determine “qualifying payment amounts” under the legislation. Currently, the No Surprises Act defines this amount as the median contracted rate recognized by the insurer on Jan. 31, 2019, with annual updates for inflation. ACR noted that this figure will be used both as part of criteria to settle payment disputes between insurers and providers, and to calculate patient cost-sharing amounts.
“We are concerned that attempts to establish the [qualifying payment amount] as the primary factor in [independent dispute resolution] determination would convert a balanced, arbitration-based law into a benchmark-style law that favors insurers at the expense of patients and providers,” ACR Chief Executive Officer William Thorwarth Jr., MD, wrote in Sept. 7 comments submitted to the Centers for Medicare & Medicaid Services. “While the vast majority of radiologists practice in-network and do not engage in out of network billing, the ACR is concerned that the [No Surprises Act] could be used to reduce network contracting and lower in network payment rates, impacting patient’s access to medical imaging.
The Radiology Business Management Association voiced similar unease around the QPA. It’s urging the administration to require health insurers to disclose how they determine qualifying payment amounts and believes details on this calculation are “extremely vague.” “RBMA strongly suggests that CMS define a more meaningful methodology for determining the QPA,” Still wrote.
Imaging experts said earlier this summer that they believe the No Surprises Act could have a “substantial” impact on radiology practices, regardless of their network status. Meanwhile, the feds just recently delayed enforcement of one key provision of the law last month, drawing support from the specialty.
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.