September 09, 2021

ACR to CMS: Stick with Independent Dispute Resolution Outlined in No Surprises Act

In July, the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, along with the Office of Personnel Management, released the first of several interim final rules to implement the No Surprises Act. These interim final rules with comment period (IFC) will implement the act’s patient protections against “surprise billing” and “excessive cost sharing” related to emergency and non-emergency services received in in-network facilities. The American College of Radiology® (ACR®) submitted comments to the agencies about the first IFC this week.

The No Surprises Act was part of the Consolidated Appropriations Act, 2021, and is scheduled to take effect Jan. 1. The law represents a significant step forward for patients and providers. The first rule addresses the law’s requirements related to patient cost sharing for emergency services, air ambulance services provided by out-of-network providers, and non-emergency services provided by out-of-network providers at in-network facilities in certain circumstances.

In addition, this IFC provides detailed information about the methodology for calculating the qualifying payment amount (QPA). The ACR comments focused on the flaws within the QPA calculation methodology. The College believes the IFC does not represent “real world” median contracted rates. The primary issue with the calculation methodology is the treatment of a contract as a datapoint in the median calculation, rather than individual claims representing datapoints. There is no weight given to the number of claims or services provided under a contract. As a result, there is potential downward skewing of the QPA calculation.

While the first IFC did not address the ACR-supported independent dispute resolution process designed to allow providers and insurers an avenue to resolve disputes over out-of-network rates, this is expected to be included in the next IFC. The ACR comment letter urged the Departments not to make the QPA the primary determinant in the IDR process, in accordance with the law.

The ACR will conduct a thorough review of the next IFC when it is released.

For questions about the No Surprises Act rules and ACR comments, please contact Katie Keysor, ACR Senior Director of Economic Policy.