October 14, 2021

ACR Provides Detailed Analysis of Flawed Surprise Billing Requirements

The American College of Radiology® (ACR®) has completed a detailed review and analysis of the Requirements Related to Surprise Billing; Part II released by the U.S. Departments of Health and Human Services, Labor and Treasury, and the U.S. Office of Personnel Management. The ACR continues to be concerned that the Biden Administration’s requirements violate the intent of the No Surprises Act (NSA) by making the Qualified Payment Amount (QPA) the primary determinant of physician payment rates in the independent dispute resolution (IDR) process.

The details of the QPA calculation were outlined in the first interim final rule released by the departments in July. The ACR raised concerns about flaws in the methodology in its comment letter on the July rule. The NSA specifies that the QPA shall be one of several factors considered in the IDR process. However, the rule states, “the certified IDR entity must select the offer closest to the QPA unless the certified IDR entity determines that credible information submitted by either party clearly demonstrates that the QPA is materially different from the appropriate out-of-network rate.”

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. The ACR continues to work with other stakeholder groups to bring the regulations in line with the law.

For more information, contact Katie Keysor, ACR Senior Director of Economic Policy.