December 09, 2021

ACR Urges CMS to Revise No Surprises Act Regulations

The American College of Radiology® (ACR®) submitted comments to the Centers for Medicare and Medicaid Services (CMS) urging the agency to revise its second interim final rule with comment (IFC) to align with congressional intent of the No Surprises Act. The law was passed late in 2020 to protect patients during insurer-provider payment disputes for out-of-network care. However, the ACR asserts the regulations released by the Biden administration violate the intent of the law by making the Qualified Payment Amount (QPA) the primary determinant of physician payment rates in the independent dispute resolution (IDR) process.

The No Surprises Act stipulates several factors be considered with equal weight in the IDR process. However, the regulations instruct IDR entities to make the presumption that the QPA is the appropriate out-of-network rate for the service in question. The IDR entities are instructed to select the offer closest to the QPA unless the entity determines that “credible information” submitted by either party clearly demonstrates that the QPA is substantially different from the appropriate out-of-network rate.

The details of the QPA calculation were outlined in the first interim final rule released by the Administration in July. The ACR raised concerns about flaws in the methodology then in its comment letter.

If the regulations are not changed, the result may be a downward trend of in-network payment rates and/or physicians being dropped from insurer networks, as already seen by insurers in North Carolina. The ACR will continue to work with other stakeholder groups to bring the regulations in line with the law.

The ACR continues to seek member input to determine how widespread attempts are by insurers to narrow physician networks. Members who receive letters from insurance companies threatening contract termination are asked to contact Katie Keysor, ACR Senior Director of Economic Policy. If providing letters to the ACR, please ensure that any specific fee data is blocked out before sending.