No Surprises Act Impact on In-Network Claims
A new Government Accountability Office (GAO) report shows that the No Surprises Act (NSA), aimed at reducing unexpected medical bills, has had limited impact on the percentage of radiology services that are billed as in-network insurance claims. The report analyzed nationwide health insurance data from 2019 through 2023, focusing on medical specialties most likely to be affected by the law’s ban on balance billing.
The NSA, which took effect in 2022, protects patients from surprise charges when they unknowingly receive care from an out of network provider. To understand how the law may have influenced provider behavior, GAO examined trends in both network participation and payment rates.
According to the GAO, the share of radiology claims billed as in network stayed high throughout the study period. From 2019 to 2023, the percentage of both facility and professional radiology claims that were submitted as in network remained largely unchanged at approximately 99 percent.
The report also looked at how much insurers paid for selected (i.e. chest x-ray, mammography, MRI brain, MRI lower extremity and CT abdomen and pelvis) in network diagnostic radiology services in outpatient hospital settings. GAO found that average professional payment rates for these services declined slightly over the five-year period. While the decrease was not dramatic, it indicates a modest downward trend in reimbursement for radiology professionals delivering in network care.
Congress required GAO to conduct the review as part of the 2021 Consolidated Appropriations Act, and additional evaluations of the law’s impact are expected in the coming years.
For more information or if you have questions, contact Katie Keysor, ACR Senior Director of Economic Policy.
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