ACR opposes ‘surprise bill’ regulation in proposed Medicare IPPS rule

The American College of Radiology (ACR) submitted written comments to CMS, taking issue with its proposed Inpatient Prospective Payment System (IPPS) rule for 2019, according to an ACR news release.

In the proposed rule, CMS sets forth requirements for hospitals to publicly disclose a list of standard charges and requests comments on how to best put that document in front of patients. But the ACR news release claims CMS mistakenly uses the hospital price transparency issue to express concerns about “surprise bills,” including those for out-of-network medical services from radiologists.

Although the ACR does support enhanced hospital price transparency, according to the release, surprise bills typically occur when a patient receives planned care from a provider within their network, but other out-of-network providers become involved in the process at some point. ACR argued that discussion of surprise bills is not applicable to Medicare and is beyond the scope of the IPPS rule.

“Issues pertaining to out-of-network bills are the result of private payors and, as a result, any policy proposals are best dealt with at the state level,” the release reads.  “Furthermore, the college believes this policy concept is outside-of-the-scope of the IPPS proposed rule and we question the validity of trying to address any perceived problems in this manner.”

The final IPPS rule is due to be released in the coming months.