Medicare Advantage Prompt Pay Act
The Medicare Advantage Prompt Pay Act establishes strict payment timelines for Medicare Advantage (MA) organizations to pay healthcare providers and suppliers for covered services. The bill requires MA plans to pay at least 95% of "clean claims" within specified deadlines—14 days for electronic claims from in-network providers and 30 days for all other claims. If payments are late, MA organizations must pay interest to providers. The legislation also authorizes civil penalties of up to $25,000 per violation and requires MA plans to publicly report their payment compliance data. This bill aims to address widespread complaints from healthcare providers about delayed payments from Medicare Advantage plans, ensuring they receive timely reimbursement similar to traditional Medicare standards.
Key Points
- 1Requires MA organizations to pay 95% of clean claims within 14 days (electronic, in-network) or 30 days (all other claims) from receipt
- 2Defines "clean claims" as those with complete data sets meeting National Uniform Billing Committee standards and applicable electronic transaction standards
- 3Mandates interest payments to providers at federal rates when MA organizations fail to meet payment deadlines
- 4Authorizes civil monetary penalties up to $25,000 per violation for non-compliance with prompt payment requirements
- 5Requires MA plans to publicly disclose payment performance data, including percentages of claims paid on time and total interest paid for late payments