The No Surprises Act (NSA) has introduced significant challenges for radiologists, as insurance companies wield increasing power in payment disputes. Recent research sheds light on the financial struggles faced by radiologists under the NSA, highlighting the broader implications for the industry. This blog explores the impact of the NSA on radiology, including its effect on in-network rates and administrative fees, as well as the concerns raised by stakeholders. Join us as we delve into the evolving landscape of radiology finance and the implications of the NSA’s implementation, and discuss paths to radiology revenue recovery.
Insurers Have the Power
According to Radiology Business, Insurance companies continue to wield power over radiologists. A new study reveals their financial challenges in NSA-related payment disputes: Radiologists break even in 11-27% of disputes, leaving insurers wielding much of the power
Published in the American Journal of Roentgenology, the study shows that radiologists rarely break even in disputes initiated under the NSA, limiting their bargaining power and favoring insurers.
The study concluded that it is “financially inviable to use the [No Surprises Act independent dispute resolution] process to resolve reimbursement disputes with payers.”
In-Network Rates are At Risk
Radiologists’ in-network rates are at risk. A recent study reveals that, despite being nearly 99% in-network before the No Surprises Act, health insurers’ misuse of the law could undermine this progress.
The study, analyzing 15 years of data, notes that effective negotiations, provider consolidation, and state-level legislation led to a decline in the out-of-network rate from nearly 13% in 2007 to 1% in 2021.
However, the NSA’s implementation is impacting these gains as insurers leverage the law to pressure in-network physicians to accept lower payments.
According to industry watchers quoted in Radiology Business, “Commercial insurers are using the legislation as a cudgel, forcing in-network physicians to accept lower payment or risk being carved out of crucial commercial contracts.”
The Dangerous IDR Access Administrative Fee Hike
The final ruling for NSA administrative fees is damaging to radiologists.
A “significant victory” came earlier this year from TMA’s prior lawsuit, leading to the successful strikedown of a proposed 600% fee hike.
However, the lawsuit was for naught. Starting in 2024, the fee to initiate the IDR process will more than double, from $50 to $115.
The new fee disproportionately impacts radiology, and the American College of Radiology remains committed to addressing concerns around access to IDR for the specialty.
Radiologists Experiencing Cash Flow Issues
61% of NSA IDR disputes still remain unresolved, causing major cash flow issues for providers, according to a new report from the U.S. Government Accountability Office released last Tuesday.
In an article from Radiology Business, stakeholders express concern over poor responses and hefty fees for providers, hindering enforcement efforts.
Further, it’s been found that over 75% of out-of-network disputes involve emergency services while “ancillary” services like radiology contribute to the rest.
With consensus emerging from Congress, the courts, and now the GAO, there is a shared agreement that the implementation of the NSA requires further attention and correction.
UnitedHealthcare Demands Radiologists Accept Lower Payments
Payers continue to take advantage of radiologists, as UnitedHealthcare demands they accept “significantly decreased payments for providing care” to remain in-network.
UnitedHealthcare is threatening to knock all Medical Imaging of Fredericksburg centers out of its network in Virginia as of December 31st if an agreement isn’t reached.
That also means patients will have to pay higher, out-of-network costs if they require an X-ray, ultrasound, or other services.
Further, patient access to necessary care is jeopardized as these medical imaging facilities are the only local providers to offer crucial cancer treatment services like PET/CT.
Thus, it is evident radiologists remain undercompensated and patient well-being is less important to UnitedHealthcare than profits.
The NSA is Pushing Radiologists to the Brink
Concerns regarding the No Surprises Act’s influence on healthcare finance are now unfolding just as anticipated, as the act continues to cause ripples in the healthcare sector and “pushes providers to the brink.”
This has already led to significant bankruptcies, including Envision Healthcare and American Physician Partners. Radiology Partners, with $2 billion in debts due, is highlighted as potentially vulnerable. Other groups on the radar include ambulance company Global Medical Response and staffing firm TeamHealth.
The NSA’s impact on out-of-network exposure continues to pressure healthcare companies, potentially leading to financial strain. The IDR process, taking over 250 days, is causing cash flow delays and heavily impacting liquidity.
What can Radiologists Do to Level the Playing Field?
Radiologists play a crucial role in the larger battle against payers’ unfair practices.
The American College of Radiology is calling on providers to report incidents where insurance companies misuse the No Surprises Act, threatening exclusion from their networks unless lower reimbursements are accepted.
“The problem with medical billing law is really in many ways a Trojan horse. The law is being used by some insurers to push through some policies that allow them to reduce reimbursement to hospitals and physicians benefiting the insurance company, but at the expense of the hospitals, physicians and the patients they take care of. This is completely unrelated to the issue of surprise medical billing,” explained Dr. Richard E. Heller, III, MD, MBA, FACR, RSNA Board member, associate CMO for health policy and communications, and national director of pediatric radiology at Radiology Partners.
By documenting these cases, radiologists contribute to building a case against these payer practices, ultimately protecting providers and patients.
Radiologists who cannot reasonably utilize the IDR process can find a more effective path to reimbursement with Allia Group’s unique bundled litigation model. Reach out to schedule a consultation.
