Bipartisan, bicameral bill would improve Medicare Advantage billing
WASHINGTON – Representatives Linda T. Sánchez (D-Calif.) and Jodey Arrington (R-Texas) and Senators Catherine Cortez Masto (D-Nev.) and Marsha Blackburn (R-Tenn.) yesterday introduced the bipartisan Medicare Advantage Prompt Pay Act, a bill to improve Medicare Advantage’s (MA) billing practices, offer certainty to health care providers who contract with MA plans and ensure that seniors are not stuck with unfair, confusing or delayed bills after receiving critical care.
“More than half of seniors eligible for Medicare are enrolled in Medicare Advantage,”said Congresswoman Sánchez. “However, too many are hit with confusing medical bills due to delayed and inconsistent Medicare Advantage billing practices. Our bipartisan bill will bring much-needed clarity to the system, ensuring healthcare providers are paid promptly and patients aren’t hit with unexpected bills long after they received care.”
“Medicare Advantage plans are delaying payments to rural hospitals and providers - resulting in service cuts, staff shortages, forced closures, and patients with unexpected medical bills months or even years later,” said Congressman Arrington. “My bipartisan Medicare Advantage Prompt Pay Act fixes this problem by requiring plans to pay hospitals and doctors on time or face penalty. By holding plans accountable and making the process more transparent, this bill protects patients, supports the hospitals and doctors who care for them, and ensures Medicare Advantage works as intended.”
“Nevadans who rely on Medicare Advantage deserve the peace of mind that when they go to the doctor’s office or hospital, their MA plan will pay providers for their care in a timely manner, and they won’t be sent a delayed bill many months later,” said Senator Cortez Masto. “This bipartisan legislation makes commonsense fixes to Medicare Advantage’s billing practices that will help health care providers and patients by bringing transparency and stability to the program.”
“Tennessee seniors should not have to worry about whether their Medicare Advantage plan will pay for their care in a timely manner,” said Senator Blackburn. “The Medicare Advantage Prompt Pay Act would improve Medicare billing practices by offering certainty to health care providers who contract with MA plans, ensuring that seniors are not burdened by unfair or overdue bills.”
While Medicare Advantage plans provide critical coverage to seniors, health care providers regularly report service and payment delays, inconsistent policies, and inappropriate denials by MA plans. Currently, there are no clear guidelines for how quickly an MA plan must reimburse providers for in-network claims. This creates unnecessary delays that could lead to providers dropping contracts with plans, jeopardizing in-network access to care for many who rely on Medicare Advantage.
The bill would address these issues by requiring MA plans to pay providers faster and more reliably. It defines ‘clean claims’ according to widely accepted national standards, sets minimum timely payment standards, and aligns rules for in-and out-of-network claims. These commonsense changes would give health care providers the certainty they need to keep partnering with MA plans and ensure that coverage continues to work for seniors.
This legislation is endorsed by the Federation of American Hospitals, American Hospital Association, National Rural Health Association, American Academy of Family Physicians, America’s Essential Hospitals, American Society of Anesthesiologists, American Psychiatric Association, Bipartisan Policy Center Action, Nevada Hospital Association, Texas Hospital Association, California Hospital Association, Vizient and OCHIN.
The full text of the bill can be found HERE.
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