The American College of Radiology (ACR) offered the Medicare Centers and Center for Medicare Services (CMS) for Consumer Information and Insurance Control (CCIIO) solutions to help ensure an independent dispute resolution (IDR) process for reimbursement of out-of-network care that is sufficiently accessible can reduce growing case backlogs and help protect patient access to care.
This roadmap would maintain all patient protections in the ACR-backed No Surprises Act (NSA) and help fix IDR implementation, but would not increase patient costs.
“These sensible measures can ensure that patients continue to have access to lifesaving care from the providers of their choice, as they are protected from surprise medical bills,” the ACR CEO said. William T. Thorwarth Jr.., MD, FACR. “Providers, insurers, regulators, legislators and other stakeholders must work together to ensure that these positive solutions offered by ACR are implemented.”
The ACR recommendations follow a January 5 meeting with the CCIO. The ACR specifically advises the agency to:
- Improve the IDR process for all stakeholders by modifying the process to allow for more robust grouping of disputed claims by the same service code family and for services paid within the previous 90 days.
- Cancel an unsupported increase of 600% in the IDR administrative costs of $50 to $350and 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 can prevent all radiologists and many other providers from participating in the IDR process.
If left unaddressed, the issues raised in the ACR letter only add to the growing reach of insurers threatening access to care. To increase profit margins without lowering beneficiary premiums, health insurers use the NSA to tight medical networks, which can force many patients to travel farther and wait longer to access care.
Blue Cross Blue Shield (BC/BS) of North CarolinaBC/BS Tennessee and CIGNA of Tennessee quote the NSA demanding suppliers accept drastic payment reductions or risk termination of the contract. Many cannot absorb such cuts and will be removed from the network.
These network restrictions ultimately impact all care, including cancer screenings, who fell during the pandemic (free registration required), and haven’t fully rebounded and can still lead to more cancer deaths.
“For the IDR process to work as intended by the No Surprises Act, it must be accessible, fair and efficient,” says Thorwarth. “These ACR solutions reinforce efforts to achieve these goals, while protecting patients from unexpected costs and preserving access to care. We urge CCIIO to work with ACR and other provider groups to implement these advances. »
