"Surprise" Billing

The American College of Radiology® (ACR®) helped ensure that federal “surprise” medical bill legislation included in the Consolidated Appropriations Act, 2021, held patients harmless and created an equitable process for (provider-insurer) independent dispute resolution (IDR).

However, the “surprise billing” interim final rule (IFR) released Sept. 30, 2021, ignored the law’s intent that the qualified payment amount (QPA) be one of many equally weighted factors considered in such disputes. Instead, the administration made the QPA the primary consideration, establishing a de-facto benchmark payment determined by insurers.

If implemented as written, the rule will result in narrower provider networks, drastic imaging cuts regardless of network status and reduced patient access regardless of their insurer.

The ACR, American College of Emergency Physicians and American Society of Anesthesiologists are protecting patient access to care and serving members by suing the federal government to block parts of the new law’s implementation that enable insurer overreach.

ACR “Surprise Billing” Resources