Bipartisan bill attempts to establish equality between MA and traditional Medicare payments
Two members of the House have introduced a bill to ensure equality between reimbursements from Medicare Advantage and traditional Medicare – and the provider is in gratitude.
Rep. Lloyd Doggett (D-Texas) and Greg Murphy (R-North Carolina) introduced a bipartisan bill on Tuesday called the Tips and Fair Pay Act.
The legislation will set a minimum payment standard, requiring the Medicare Advantage program to repay the provider at a rate not less than the traditional Medicare Parts A and B. However, it can still make the payer and provider agree to higher interest rates if they choose.
The bill also includes rules for timely payment of claims within the network, similar to the timely payment requirements for Medicare Part D.
Medicare Advantage payments are based on the benchmark for traditional Medicare spending, but current laws do not require the Medicare Advantage program to pay the provider at the same rate. As a result, many health systems and other provider organizations lost unsustainable funds – forcing many to withdraw from contracts through the Medicare Advantage program.
Nearly 30 health systems have removed their Medicare Advantage plans so far this year.
Providers must choose between large reimbursement delays, which are often more than the delays that are truly owed, administrative totals, denial of denial or withdrawal from the MA contract altogether. Many providers are already at risk of closure and the MA now covers more than half of the participants, ensuring we have to pay in a timely manner before every community. statement.
Murphy, co-sponsor of his bill, also noted that physicians who see Medicare Advantage beneficiaries face higher rates of prior authorization denial, which jeopardizes the safety of patients, especially for those with chronic illness, cancer or mental health issues.
The bill has been endorsed by several major lobby groups representing provider organizations and physicians, such as the American Basic Hospital, the American Academy of Family Physicians, the American College of Physicians, the National Rural Health Association, the Prime Minister and the American Nurses' Anesthesiology Association.
Bruce Siegel, chief executive of the U.S. Basic Hospital, praised the legislative efforts in a statement saying it would help alleviate the ongoing financial distress for providers.
“The swift and fair pay bill is a step in the right direction, providing specific steps to address serious hospital reimbursement. We will continue to support common sense legislation like this, aiming to better maintain and support our hospitals and the communities they serve.”
Photo: Designer491, Getty Images
