“Overnight, the government created a $5 billion market, sanctioned employer balance billing (with an 83% success rate for providers) and gave a 3x-4x pay raise to folks subject to the NSA/IDR regulatory framework. The NSA/IDR process is not a way to occasionally resolve reimbursement disputes. It is a business model.”
By Doug Aldeen – ERISA Healthcare Attorney and Fractional General Counsel – Visit my website41m
The American College of Radiology is seeking to rally support for proposed legislation that would punish payers for failing to pony up after losing disagreements over reimbursement consistent with the No Surprises Act IDR process.
Briefly and by way of background, this bill aims to close enforcement gaps by increasing penalties for not complying with payment deadlines. The bill would fine insurers that fail to pay radiologists and other physicians within 30 days of resolving a dispute. It also would bolster transparency and accountability for payers shirking the law’s rules. The Radiologist’s have previously advocated for these changes alongside the American College of Emergency Physicians and American Society of Anesthesiologists, whose members also are disproportionately impacted by the surprise billing. Emphasis added.
More to the point, recently released data from the Centers for Medicare & Medicaid Services show that providers instigated most of the disputes (81%) in the first half of 2025, and healthcare facilities initiated a higher share of these quarrels (19%) compared to the previous year (13%). As was the case with the last data release, most payment disputes were initiated by a limited number of parties and their representatives. Altogether, the top 10 initiating parties accounted for 69% of all payment disputes, similar to 2024’s second half (71%). Interestingly, Radiology Partners (“RP”/a/k/a “RIP” acronym TBD), the country’s largest imaging group, was No. 3 in the first quarter of 2025, launching over 63,000 disputes (or 12%). RIP landed at No. 4 in Q2, initiating nearly 48,000 disputes (or 8%). HaloMD, a Texas-based entity that handles disputes on behalf of providers, was No. 1 both quarters, followed by TeamHealth, a multispecialty care group out of Tennessee. “RIP” was previously listed as the No. 1 initiator, based on data from the second half of 2024.
Paul Harvey “The Rest of the Story:
Overnight, the government created a $5 billion market, sanctioned employer balance billing (with an 83% success rate for providers) and gave a 3x-4x pay raise to folks subject to the NSA/IDR regulatory framework. The NSA/IDR process is not a way to occasionally resolve reimbursement disputes. It is a business model.
Sunday Morning Bathroom Read Investor and Portfolio Recommendation:
Caveat: I am not even remotely qualified to provide any investment advice. I cannot even operate the TV force without assistance. With that being said, find a way to invest in medical practices that are subject to the NSA/IDR process. It is an ATM machine.
