Importance of Medicare Advantage Prompt Pay Act for Healthcare Providers

A crucial meeting in Washington, D.C., gathered congressional members and leaders from hospitals and health systems to address how Medicare Advantage payment delays affect healthcare services, staffing, and patient care access. The focus was on the Medicare Advantage Prompt Pay Act (H.R. 5454/S. 2879), co-sponsored by Representative Linda Sanchez and Representative Jodey Arrington, which seeks to establish a federal standard for prompt payment. This legislation aims to ensure healthcare providers receive timely compensation from Medicare Advantage plans, mandating that these plans disburse at least 95% of clean claims within two weeks for in-network services and a month for out-of-network services.

Erik G. Wexler, president and CEO of Providence Health and Services, and a trustee with the American Hospital Association, underscored the bill's importance. He remarked, “Hospitals are always there for patients — we deliver care in urgent, often life-threatening situations without hesitation. But too often, we’re not paid on time for care that has already been provided, creating instability that ultimately affects patients and the providers who care for them. The Medicare Advantage Prompt Pay Act is a reasonable, bipartisan solution to ensure patients can rely on timely care and providers can count on timely payment.”

Contributing to the discussion were other healthcare representatives, including Lorin Martin from Westchester Medical Center Health Network, Collin McLarty, CEO of Cogdell Memorial Hospital, and Josh Reeves, vice president of development and advocacy at Ozarks Healthcare. Their insights are vital as the industry seeks solutions to improve payer-provider relationships and ensure regulatory compliance in payment processes.