RANT projects $51M in No Surprises Act admin costs

Radiology Associates of North Texas has released an internal analysis projecting more than $51M in avoidable administrative costs tied to No Surprises Act batching rules and unpaid IDR awards.

The Fort Worth-based group described itself as the largest independent physician-owned radiology practice in the U.S. It said the findings point to inefficiencies in the federal independent dispute resolution process.

RANT said it has prevailed in approximately 95% of finalized IDR disputes involving Blue Cross Blue Shield of Texas. More than $3.5M in awarded balances remains unpaid, with nearly $1.64M outstanding for more than 120 days, according to the group.

Blue Cross Blue Shield of Texas has paid approximately 2% of awarded balances, RANT said. Kurt Schoppe, MD, president of the practice, said unpaid arbitration awards weaken the credibility of the dispute process.

Batching rules are also increasing filing volume, according to the analysis. RANT estimated that an ideal batching process would involve approximately 1,369 batches and $1.05M in administrative costs.

Under the current federal interpretation advocated by BCBS of Texas, the group said it would need approximately 68,450 batches, with total administrative costs of $52.7M. The projected increase is more than $51.6M.

Federally mandated dispute-processing fees include a $115 administrative fee per batch and a $655 arbitrator fee per batch, according to RANT. The group said those costs can exceed the value of a typical radiology claim, which it estimated at about $110.

CMS describes the federal IDR process as the mechanism providers, facilities, air ambulance providers, and health plans can use when open negotiations do not resolve certain out-of-network payment disputes.

RANT is calling for federal legislation that would create penalties for insurers that do not comply with binding IDR payment determinations. The group also wants CMS batching guidance modernized to reduce administrative costs.