With price transparency rules, shouldn't we be able to go in and get a reasonable calculation comparison?
The easiest calculation would be for those among us in an MSA with at least 2 other radiology groups. Should be able to see what the other providers are getting somewhere on the provider's website. Granted you will see the current rate and the QPA should be based upon January 2019 fees. But you should at least get a reasonableness test. And don't forget about the indexing. Whatever they tell you today should be increased by 1.0768582128 (Sep - Aug CPT increase) on January 1, 2022. Through the power of compounding the QPA will be up 1.1466950506 January 2023. And I'm expecting 1.1914305256 by January 2024. All those group at or below the QPA could be up by 20% if they are OON by January 2024.
I'm in a one county MSA and we're the only radiology providers in that county. My QPA will be baed upon a calculation for the entire state. Payers have to get a sample size of at least 3 within your MSA to perform the QPA calculation.
And the final issue - payers aren't posting their pricing yet.
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R. Christopher Sluder CPA
Administrator
Rome Radiology Group
Rome GA
(706) 291-2661
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Original Message:
Sent: 09-15-2022 12:38
From: Douglas Kraus
Subject: QPA
So if you go to arbitration and the payor is using a QPA (allegedly based upon the median contracted rate), what avenues do you have to dispute their data especially after considering they may be doing what is suggested in the article below? I believe there is some language in the regs that the fed will enforce validation of the QPA, but surely no one believes that will ever occur.
Just had a call with Cigna and they are quoting rates that are quite simply absurd, and I find difficult to believe any radiology practice would accept such low rates.
ACR, other groups cry foul over insurers' methods for calculating out-of-network payments| Radiology Business | remove preview |
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Douglas G. Kraus, CPA
Chief Financial Officer
South Texas Radiology Group, P.A.
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