ACR Voices Opposition for Latest Version of Anti-Surprise Billing Legislation

16 December 2019 - Collaborative Imaging
Anti-Surprise Billing Legislation - Richard Edmund Neal
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Image courtesy: The Hill

The Lower Health Care Costs Act of 2019, as listed at Congress.gov, originally introduced on June 19, 2019, sought to end surprise medical billing – Anti-Surprise Billing Legislation. The initial bill focused on establishing an independent settlement organization. It also focused to standardize billing and setting thresholds for how companies should approach balance billing for patients. Unfortunately, the legislation stoked uncertainty in the market. And on Tuesday, December 10, 2019, the American College of Radiology (ACR) voiced its disapproval for the latest rendition of the bill. The disapproval is a bipartisan agreement about surprise bills that came to fruition on December 8, 2019.

It is important to note that this agreement has not yet translated into an actual piece of passed legislation. However, it is now much closer to passage with the looming funding deadline in sight. But first, let’s look closer at what the ACR did and did not say regarding the bill.

The Need to Reduce the Rate of Surprise Medical Bills

The ACR does agree with the need to reduce the rate of surprise medical bills. However, the ACR goes on to explain that granting broad powers to insurers to deny claims due to latency in paperwork or limited provider networks would increase risk. Such risks come in the form of denials, even when patients are fully covered and when such test results go beyond the original spectrum and a government-mandated cap on dispute resolution.

The concerns voiced by the ACR also revolve around the financial burden placed on consumers. The bill may grant insurers more wiggle-room to charge higher deductible and co-payments to patients. Meanwhile, provider payments will slow.

A Surprise-ending Piece of Legislation Exists

A past example of a surprise-ending piece of legislation exists, which further supports the ACR position. In August, a study published by the American Journal of Managed Care, reports Kentucky Today, “found bills aiming to reduce the costs of surprise bills typically lead to lower provider payment rates and increased physician group consolidation.” Furthermore, California passed a similar surprise billing law and has experienced a 48% increase in complaints regarding patient access to care. Unfortunately, anti-surprise billing laws tend to result in more network-based practices, lowering competition, and effectively increasing costs to consumers.

Under the agreement struck on December 8, 2019, bills of less than $750 would be paid at the default rate. Meanwhile, bills over that amount would require arbitration, increasing the time between services rendered and payment received, reports Vox.com.

Avoid Another Shutdown

The bill is now part of the upcoming spending bill, which must pass before December 20, 2019, to avoid another shutdown. To gain the favor of Mitch McConnell, the latest agreement includes a mandate to raise the smoking age to 21. Unfortunately, even now, this newest piece of legislation rests in the hands of House and Senate leaders. Congress has less than one week to work out any remaining details of the spending bill. This is done to transform the once-dimming view of surprise billing into a signed law.

For now, the legislation is still a piece of a bill, and the growing backlash from the ACR and other health entities may lead to another stall. However, this is a precarious time for the industry. If the legislation passes, either as an independent bill or part of the spending bill, it will have wide-ranging ramifications that shudder through the industry. Now the waiting game begins, and private practitioners, including radiologists, need to start thinking about how they can work with patients and insurers alike to get their fair share of payments and avoid delays under the new anti-surprise billing legislation. As of December 13, experts do not expect the legislation to pass this year, reports Peter Sullivan of the Hill. Please stay tuned. We will provide another update as this legislation moves through Congress.