Researchers from Houston-based University of Texas MD Anderson Cancer Center and the Reston, Va.-based Harvey L. Neiman Health Policy Institute analyzed retrospective data compiled from claims in Optum’s de-identified Clinformatics Data Mart Database.
Here are five things to know:
- A total of 5,039,142 imaging claims from radiologists were out of network between 2007 and 2021, accounting for 6.3% of all imaging claims.
- The overall out-of-network imaging claim rate decreased from 12.6% in 2007 to 1.01% in 2021 at a rate of .74 percentage points annually.
- The out-of-network claim rate during inpatient stays was 5.0% between 2007 and 2021 and decreased by .54 percentage points annually.
- The out-of-network claim rate for same-day ED visits that did not lead to an inpatient admission was 2.1% between 2007 and 2021 and decreased by 0.26 percentage points annually.
The findings may be a result of “effective negotiations between radiologists and commercial payers and new state-level surprise billing laws,” the study authors wrote.
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