The American College of Radiology (ACR) has offered the Centers for Medicare and Medicare Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) solutions to help ensure an independent dispute resolution (IDR) process for out-of-network care reimbursement that is sufficiently accessible, can ease growing case backlogs, and help safeguard patient access to care.
This roadmap would maintain all patient protections in the ACR-backed No Surprises Act (NSA) and help correct IDR implementation but not raise patient costs.
“These sensible steps can ensure patients continue to have access to lifesaving care from the providers of their choice as they are protected from surprise medical bills,” says ACR CEO William T. Thorwarth Jr., MD, FACR. “Providers, insurers, regulators, lawmakers, and other stakeholders must work together to ensure that these ACR-proposed positive solutions are implemented.”
The ACR recommendations follow a January 5 meeting with CCIIO. The ACR specifically advises the agency to:
- Enhance the IDR process for all stakeholders by modifying the process to permit more robust batching of disputed claims by the same family of service codes and for services paid within the previous 90 days.
- Roll back an unsupported 600% increase in the IDR administrative fee from $50 to $350, and Independent Dispute Resolution Entity (IDRE) fees to more than $1,200 in many cases. These fee increases are often higher than the amount in dispute and may preclude all radiologists and many other providers from taking part in the IDR process.
If not corrected, the issues raised in the ACR letter only add to growing insurer overreach that threatens access to care. To increase profit margins without lowering beneficiary premiums, health insurers are using the NSA to narrow medical networks, which may force many patients to travel farther and wait longer to access care.
Blue Cross Blue Shield (BC/BS) of North Carolina, BC/BS of Tennessee and CIGNA of Tennessee cite the NSA in demanding providers accept drastic payment cuts or risk contract termination. Many cannot absorb such cuts and will be dropped from network.
These network restrictions ultimately impact all care, including cancer screenings, which plummeted during the pandemic (free registration required), and have not fully rebounded and may yet lead to more cancer deaths.
“For the IDR process to work as the No Surprises Act intended, it must be accessible, fair and efficient,” says Thorwarth. “These ACR solutions strengthen efforts to achieve those goals, while safeguarding patients from surprise costs and preserving access to care. We strongly urge CCIIO to work with ACR and other provider groups to implement these steps forward.”