September 30, 2021

Surprise Billing Rule Misses Mark on Independent Dispute Resolution Process

The Departments of Health and Human Services, Labor and Treasury, and the U.S. Office of Personnel Management released the Requirements Related to Surprise Billing; Part II Sept. 30. On initial review, the American College of Radiology® (ACR®) is disappointed that the regulations violate the intent of the No Surprises Act by making the Qualified Payment Amount (QPA) the primary determinant of physician payment rates in the independent dispute resolution 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.

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 will continue to work with other stakeholder groups to bring the regulations in line with the law.

The ACR will provide a detailed summary of the rule in the coming days. The Departments posted a Fact Sheet and Press Release on the Centers for Medicare and Medicaid Services website.

For more information, contact Katie Keysor.