The American College of Radiology, Zotec Partners and Strategic Radiology met with CMS Chief of Staff Rebekah Armstrong to raise concerns about insurer payment practices and the federal dispute resolution process under the No Surprises Act.
The groups said radiology practices have faced stagnant or reduced in-network contract rates, pushing some out of network and into the federal Independent Dispute Resolution process to negotiate reimbursement, according to an Aug. 20 ACR news release. Radiology Associates of North Texas told CMS one large Texas payer has refused to negotiate adequate in-network rates and has not made market-based offers through IDR. ACR said payers frequently miss the required 30-day window to pay awards when providers prevail.
The groups also raised concerns about the Qualifying Payment Amount, the benchmark meant to reflect 2019 median in-network rates adjusted annually for inflation, which ACR said has become disconnected from market conditions. The Fifth Circuit Court of Appeals recently ruled key aspects of the federal QPA calculation methodology unlawful.
Ms. Armstrong acknowledged limits on CMS’ ability to enforce compliance and penalize insurers under the law, and said the issue is a high priority for the agency.
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