The American College of Radiology® (ACR®) participated in a Jan. 5 stakeholders meeting with the Centers for Medicare and Medicaid Services’ (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) to collect feedback regarding the independent dispute resolution (IDR) process created during implementation of the No Surprises Act.
ACR contends that patients’ access to their chosen providers is threatened if the IDR process is not corrected. Patients may be forced to drive longer distances to providers and wait longer to receive care.
Key IDR-related issues discussed at the meeting included claim eligibility determination, the open negotiation period and additional concerns related to the overall IDR process. ACR and other meeting stakeholders shared several issues with CCIIO staff, including the need to simplify and streamline the IDR batching process. In addition, ACR and other meeting participants expressed their surprise and dismay at CMS’ recent 600% increase to the IDR administrative fee. ACR explained that, since the vast majority of imaging charges are less than the new fee of $350, the increase all but excludes imaging from participating in the IDR process.
ACR sent a communication to CCIIO following the meeting that outlines solutions that the agency can take to avert the current IDR challenges and protect patients’ ability to receive care in their communities. None of the steps offered by the ACR impact NSA patient protections or raise patient costs.
ACR-offered solutions would ensure:
• That patients have access to an adequate provider network.
• Access to a fair provider-insurer dispute resolution process.
• NSA implementation complies with No Surprises Act (NSA) statutory text.
ACR continues to seek input on how NSA implementation has impacted members so that we can share this information with the pertinent federal agencies. If you have information to share, please contact Katie Keysor, ACR Senior Director of Economic Policy.