Hi Doug
I'm sure Bob Still will be circulating RBMA's comments.
I think the concern about plans terminating agreements is legitimate (we've had a couple this year), but maybe more an issue for those that have contract rates well above others in the same market.
Keep in mind that the QPA is usually going to be based on the plan's median contract rate in that insurance market as of January 31, 2019, adjusted by the CPI-U. When I checked recently, CPI-U was up 7.8% since that date, and it seems that moderate inflation may continue for a while. The QPA is probably going to escalate much faster than most of your managed care contract rates.
My big concern about the QPA is that the payors will manipulate the data set used to determine the median contracted rate. They've never done that before...except the numerous times they have been sued and lost/settled over skewed UCR data.
Keep in mind that the QPA is only advisory to the federal IDR entity. Actually going to the IDR process might be a crapshoot. The main IDR regulations are still to come, but my read so far is that they have to choose between the plan and provider offers. It isn't clear to me that they could split the difference, for example. We'll have to see that parameters CMS sets out for the IDR decision making process, and what the cost is going to be.
The requirements in order to balance bill are onerous, and unrealistic or impossible in some cases. But the IFR also says that radiologists can't ever balance bill. Unless that gets changed, I think you would just have to do the minimum notices that everyone will have to do. Even if the door to balance billing with proper notice is opened, I doubt that many radiology groups will want to go there.
One other major concern is the timing. The IFR is effective for providers on January 1, 2022, but it isn't effective for health plans until the later of January 1, 2002, or plan years beginning after that date. You could theoretically go most of the year where you have to follow the rules, but some health plans don't. Not to mention, most providers will struggle to get all of the required notices and processes in place to comply before January 1, and we don't even have the main rules for health plans or IDRs yet.
While there are definitely some land mines in the IFR and too many things are poorly defined, on balance I think it's more good than bad thanks to the inflation adjustment to the QPA, at least compared to what it could have been. We'll have to see if they make any tweaks based on comments.
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
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Original Message:
Sent: 09-08-2021 17:17
From: Douglas Kraus
Subject: Interim Final Rule w Comments No Surprises Act
Does anyone have either the comments the ACR provided, I believe the deadline was yesterday, or if the RBMA submitted comments a copy of those?
I finally made it through the IFR and I'm surprised (not a joke either) that there hasn't been more discussion as to the implications for radiology.
Still trying to wrap my mind around all the nuances:
Have practices seen aggressive tactics by payors to cancel agreements with the notion the QPA will be less than current contractual agreements?
What about the notice requirements - my basic understanding based upon the IFR, these seem to be rather burdensome - so you/or the facility have to hand a piece of paper to every patient explaining the regs/post on website, has to be searchable, etc, etc, etc.
Maybe I'm just gun shy, but it's always the details that are overlooked by our lovely legislators that create the most havoc,
Also - has anyone seen a good summary of the rules??
I know United has certainly gone after groups in Texas, maybe nationwide, and we continue to battle them on rates.
The sad thing is their data is terribly mistaken yet they have no one to property analyze it so I have to lead them through it.
On a brighter note, we have been able to use the Tx Balance Billing rules to our advantage. A contract with an ACA plan we have been dealing with for at least 2 years now.
Happy Wednesday
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Douglas G. Kraus, CPA
Chief Financial Officer
South Texas Radiology Group, P.A.
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