The healthcare sector is one of the most critical and essential sectors across the globe. No country can think of sustainable growth if its population does not remain healthy. The average well-being of the national population largely depends on the efficient working of the healthcare sector of the nation.

The health care sector in any country consists of the medical care providers, doctors, nurses, and ancillary organizations that help in the appropriate functioning of the industry. If any of these fails to function optimally, the entire health care sector is sure to suffer the consequences. Hence, ensuring the efficient functioning of each of these laterals of the health care sector is essential to keep its performance going.

Also, patients are an essential part of this sector. Patients are those who get benefitted from this sector and for whom the entire process runs. Without patients, the healthcare sector will cease to exist. Hence, the domain must emphasize on putting the requirements of the patients on the frontline while revising the operational procedures.

One of the most common terms that have created quite a buzz in the healthcare sector is surprise billing or out of network billing. Patients were surely not happy with such an arrangement. However, recently, there has been an amendment in the billing procedures, and revised legislation has been issued following the amendment as well to make the surprise billing a rare incident in the healthcare sector.

ACR or American College of Radiology has already praised the efforts and has added that further improvements will be added to the current set of facilities of the healthcare sector. ACR has emphasized on making the sector more patient-friendly so that more people can access the facilities available. Here is a brief about surprise billing.

Surprise Billing

As the name suggests, surprise billing is a bill that the patients used to receive once the treatment was over as a surprise. However, surprise bills were seldom a pleasant surprise. Mostly, the amount reflected in these bills were the differences between the insured sum and the chargeable services availed by the patient which were not covered under the insurance, the surprise bills were particularly huge for those who used to opt for an out of the network facility for treatment.

At times of emergency, plenty of people do not check the in-network facilities before admitting the patient to any specific hospital or medical care unit. However, when the treatment gets over, and the patient gets released, the price of not checking the in-network list used to appear in the form of surprise bills. Therefore, patients were particularly not happy with this arrangement. In times of emergency, life comes first and not the list of the in-network facilities.

If any out-network facility is close, people generally opt for it during an emergency, leaving the in-network facilities located at a distance behind. This has been a concern for many of the patients for long.

The Amendment

It was challenging to trade between time and network facilities when emergencies arose.  Hence, IDR was necessary to be added to the existing legislation to address the issues of surprise billing. ACR has already issued a statement praising the inclusion of IDR into the process of law.

This inclusion will surely turn out to be of positive impact for the entire healthcare sector. This amendment has now enabled the out of the network physicians to initiate an IDR for in-network claims amounting more than $1250. ACR has credited this initiative as a “critical step” in removing the misappropriations arising out of the surprise medical bill issues.

On July 16, ACR expressed their concern about the absence of IDR in the No Surprises Act. It declared the No Surprise Act to be incomplete without IDR in it. Over 100 medical organizations agreed to this notion and signed a letter addressed to the Energy and Commerce Committee, requesting to include IDR in the No Surprises Act.

As IDR got included in the act and the legislation got amended accordingly, ACR assured that further legislations are there in the pipeline to support the step of inclusion of IDR. The aim of ACR has always been to make healthcare sector services more impactful. Also, they are committed to making the existing facilities better.

Other Opinions

However, as ACR continued to praise the inclusion of IDR above the amount of $1250, many o the stakeholders like ACEP suggested lowering the threshold amount. According to ACEP, most of the emergency cases would quote a cost less than $1250 and will not qualify for the IDR arbitration. Hence, the benefits of the amendment will cease to reach the majority of the medical care sector.

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