Surprise billing should be addressed by private insurers, not Medicare, American College of Radiology contends

The American College of Radiology has come out against provisions to curb surprise billing s in CMS' 2019 Medicare Inpatient Prospective Payment System proposed rule released April 24.

The ACR, which represents more than 36,000 diagnostic radiologists, interventional radiologists, radiation oncologists, nuclear medicine physicians and medical physicists, submitted comments to CMS June 25 related to the rule. The college praised CMS for its price transparency efforts in the rule, such as its proposal requiring hospitals to publish a list of their standard charges online. However, it expressed some concerns about the rule, which also solicited comments on how price transparency can be improved, and noted specific concerns such as surprise out-of-network billing by providers and unexpected fees.

The ACR said it "questions any perceived connection between the need to increase hospital price transparency and alleviating so-called 'surprise bills,' or patients receiving care from physicians, such as radiologists, who are out-of-network but located at in-network facilities."

The college also made it clear it believes surprise billing issues should be regulated by state lawmakers, as they involve private insurers rather than Medicare.

"Surprise bills typically arise when an individual receives planned care from an in-network provider, but other providers brought in to participate in the patient's care do not participate in the same network," the ACR wrote. "The college, however, views surprise bills as an issue largely stemming from the actions of private insurers and not government payers. In fact, Medicare classifies practitioners into three categories: participating, nonparticipating, or opt out/private contracting providers."

In addition to the surprise billing provisions, the college also submitted comments on national cost center cost-to-charge ratios for radiology, CT scan and MR, as well as the future direction of the hospital-specific Promoting Interoperability Program.

Read the college's full comments here.

Emily Rappleye contributed to this report. 


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