November 02, 2023

Feds Appear to Acknowledge Radiology Surprise Billing Implementation Concerns in New Proposed Rules

The U.S. Departments of the Treasury, Labor, and Health and Human Services issued a new proposed rule Oct. 27, that outlines policies related to the No Surprises Act (NSA) independent dispute resolution (IDR) process. The rule addresses disclosure of claim eligibility information by insurers, communication during the open negotiation period, collection of administrative fees and batching multiple claims into a single IDR dispute.

On initial review of the proposed rule, the departments appear to address the concerns raised by the American College of Radiology® (ACR®) with regard to lack of communication about claim eligibility, IDR backlogs and access to the IDR process for low-cost claims, including batching requirements. The government proposes to expand batching to allow multiple codes from a single patient encounter. In addition, the departments propose to allow batching by groupings of Current Procedural Terminology® (CPT®) codes, rather than single CPT codes. These are positive changes, but ACR remains concerned about other proposals, including limiting batching to 25 line items in a single dispute.

ACR continues to review the details of this proposed rule and will provide a detailed summary. For more information or if you have questions, contact Katie Keysor, ACR Senior Director of Economic Policy.