Medicare Advantage Prompt Pay Act

Key Points

• Medicare Advantage plans would be required to pay at least 95% of clean claims within strict deadlines: 14 days for electronic claims from in-network providers and 30 days for all other claims, including paper submissions and out-of-network providers.
• When a Medicare Advantage plan misses the payment deadline on a clean claim, it must pay interest to the provider at the same rate the federal government uses for its own late payments, running from the day after the deadline through the date payment is actually made.
• The government could fine Medicare Advantage organizations up to $25,000 each time they are found to be out of compliance with the prompt payment rules, giving regulators real enforcement power.
• Medicare Advantage plans would have to publicly report detailed data on their payment performance, including how many claims were paid on time, how many were late, and how much interest they paid out over the previous 12 months.
• If enacted, these new prompt payment rules would take effect for services provided on or after January 1, 2027, giving insurers and providers over a year to prepare for the new standards.

Votes

No votes have been recorded for this legislation yet.