Fort Worth, Texas-based Radiology Associates of North Texas projected more than $51 million in avoidable administrative costs tied to current No Surprises Act arbitration batching rules and unpaid Independent Dispute Resolution awards.
In a May 19 news release, the physician-owned radiology practice said it prevailed in approximately 95% of finalized IDR disputes involving Blue Cross Blue Shield of Texas. More than $3.5 million in awarded balances remains unpaid, including nearly $1.64 million outstanding for more than 120 days. The payer has paid approximately 2% of awarded balances, according to RANT.
The group also said current federal batching interpretations are increasing administrative costs by requiring providers to split similar claims into thousands of smaller arbitration filings with separate fees.
RANT estimated an ideal batching process would involve approximately 1,369 batches and $1.05 million in administrative costs. Under the current federal interpretation advocated by Blue Cross Blue Shield of Texas, the group projected approximately 68,450 batches and $52.7 million in administrative costs — a projected increase of more than $51.6 million.
Those costs include a $115 administrative fee and $655 arbitrator fee per batch. For a typical radiology claim averaging approximately $110, administrative costs can exceed the underlying medical service multiple times over, the release said.
The issue follows a recent Fifth Circuit Court ruling that providers do not have a private right of action under the No Surprises Act to enforce unpaid IDR awards.
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