New Bill Aims to Equalize Medicare Advantage Payments: Why It Matters

Medicare Advantage payments and reimbursement concept with clipboard.

Medicare Advantage and Traditional Medicare: A Growing Divide

In recent years, a significant disparity has emerged between the reimbursement rates for Medicare Advantage (MA) plans and traditional Medicare. As more people enroll in MA, which now covers over half of Medicare beneficiaries, providers are increasingly frustrated with the lower reimbursement rates and delayed payments from MA plans. The health systems are expressing growing concern, and the introduction of the Prompt and Fair Pay Act serves as a timely response to these mounting challenges.

The Prompt and Fair Pay Act: Key Provisions

In a bid to address these issues, Representatives Lloyd Doggett (D-Texas) and Greg Murphy (R-North Carolina) introduced the Prompt and Fair Pay Act. This bipartisan legislation aims to ensure that MA plans reimburse providers at least at the same levels as traditional Medicare for Parts A and B. This change would represent a critical shift designed to alleviate the financial strain that many healthcare providers currently face, as nearly 30 health systems have opted out of MA contracts this year alone.

Why Timely Payments are Essential for Healthcare Providers

The act also aims to implement rules for prompt payment of in-network claims—a necessity when considering the challenges faced by healthcare providers today. Long reimbursement wait times combined with inadequate payment amounts can severely impact the ability of health systems to provide quality care, particularly for patients with chronic conditions. As Representative Murphy noted, patients' safety is jeopardized when physicians encounter excessive prior authorization hurdles from MA plans.

Community Impact: Ensuring Access to Care

Experts warn that the situation can lead to healthcare deserts if adequate measures are not taken. The Prompt and Fair Pay Act is not just about financial recovery for healthcare providers; it’s about ensuring that communities do not suffer from a lack of accessible healthcare. The bill has received broad support from major lobbying groups representing health professionals, underlining its importance in safeguarding patient care and improving the healthcare landscape.

A Call for Action

As the healthcare landscape continues to evolve, advocacy for fair payment practices is critical. Stakeholders in the healthcare sector must actively engage with this legislation, as its enactment could determine the future of patient care and provider sustainability. By supporting bills like the Prompt and Fair Pay Act, we can help ensure that healthcare remains both accessible and equitable. Interested parties should reach out to their representatives to express support for this vital legislation.

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New Bill Aims to Equalize Medicare Advantage Payments: Why It Matters

Medicare Advantage and Traditional Medicare: A Growing Divide

The Prompt and Fair Pay Act: Key Provisions

Why Timely Payments are Essential for Healthcare Providers

Community Impact: Ensuring Access to Care

A Call for Action

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