Two
members
of
the
House
of
Representatives
have
introduced
a
bill
seeking
to
ensure
parity
between
reimbursements
for
Medicare
Advantage
and
traditional
Medicare
—
and
providers
are
reacting
with
gratitude.
The
bipartisan
bill,
called
the
Prompt
and
Fair
Pay
Act,
was
introduced
on
Tuesday
by
Reps.
Lloyd
Doggett
(D-Texas)
and
Greg
Murphy
(R-North
Carolina).
The
legislation
would
set
a
minimum
payment
standard,
requiring
Medicare
Advantage
plans
to
reimburse
providers
at
no
less
than
the
rates
paid
under
traditional
Medicare
Parts
A
and
B.
However,
it
would
still
allow
payers
and
providers
to
agree
on
higher
rates
if
they
choose.
The
bill
also
includes
rules
for
timely
payment
of
in-network
claims,
similar
to
the
prompt
payment
requirements
already
in
place
for
Medicare
Part
D.
Medicare
Advantage
payments
are
based
on
benchmarks
from
traditional
Medicare
spending
—
but
current
law
doesn’t
require
Medicare
Advantage
plans
to
pay
providers
at
the
same
rates.
Because
of
this,
many
health
systems
and
other
provider
organizations
are
losing
an
unsustainable
amount
of
money
—
forcing
many
to
exit
their
contracts
with
Medicare
Advantage
plans.
So
far
this
year,
nearly
30
health
systems
have
dropped
their
Medicare
Advantage
plans.
“Providers
are
having
to
choose
between
substantial
reimbursement
delays
that
are
often
less
than
what
is
truly
owed,
administrative
burdens,
care
denials,
or
an
outright
withdrawal
from
MA
contracts.
With
many
providers
already
at
risk
of
closure
and
MA
now
covering
more
than
half
of
enrollees,
it
is
essential
that
we
ensure
prompt
and
fair
payments
before
every
community
is
a
health
care
desert.
Our
bill
is
an
important
step
to
protect
patients
and
providers,”
Doggett
said
in
a
statement.
His
co-sponsor
of
the
bill,
Murphy,
also
pointed
out
that
physicians
who
see
Medicare
Advantage
beneficiaries
face
higher
rates
of
prior
authorization
denials
—
which
jeopardizes
patient
safety,
especially
for
those
with
chronic
illnesses,
cancer
or
mental
health
issues.
The
bill
has
been
endorsed
by
several
major
lobbying
groups
representing
provider
organizations
and
physicians,
such
as
America’s
Essential
Hospitals,
American
Academy
of
Family
Physicians,
American
College
of
Physicians,
National
Rural
Health
Association,
Premier
and
the
American
Association
of
Nurse
Anesthesiology.
Bruce
Siegel,
CEO
of
America’s
Essential
Hospitals,
praised
the
legislative
effort
in
a
statement,
saying
that
it
would
help
alleviate
providers’
ongoing
financial
woes.
“The
Prompt
and
Fair
Pay
Act
is
a
step
in
the
right
direction,
providing
concrete
steps
to
fix
woefully
inadequate
hospital
reimbursements.
We
will
continue
to
support
common
sense
legislation
like
this
that
aims
to
better
sustain
and
support
our
hospitals,
and
the
communities
they
serve,”
he
declared.
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