In a disturbing signal of the instances, Medicare this week applied a change to its claims-processing system that provides two further digits to cash quantities, increasing the fields from eight digits to 10. The change now permits for billing and cost totals of as much as $99,999,999.99, or a penny shy of $100 million.
In a discover launched final month, the Facilities for Medicare & Medicaid Providers (CMS) defined the change, writing, “With the rise of Half B procedures/remedies exceeding the $999,999.99 limitation, CMS is implementing the growth of show screens for financial quantity fields associated to billing and cost inside [the Fiscal Intermediary Shared System (FISS)] to simply accept and course of as much as 10 digits ($99,999,999.99).”
The FISS is the processing system utilized by hospitals and docs’ workplaces to course of Medicare claims.
Stat information, which first reported the replace, famous that it isn’t the primary time CMS has struggled to make room for ever-increasing drug and remedy costs in its claims processing techniques. In 2022, the company needed to give technical recommendation to docs submitting claims for chimeric antigen receptor (CAR) T-cell remedy, which is used to deal with blood cancers. CAR T-cell therapies run round half 1,000,000 {dollars}, or eight digits. However in a distinct claims processing system, referred to as the Multi-Service System (MCS), the cash quantity fields solely included seven digits. In that case, somewhat than increasing the sphere, the CMS requested that docs divide the invoice by both 5 or 10, relying on the dimensions, after which invoice Medicare 5 or 10 separate instances for a single declare.
CAR T-cell therapies aren’t the one remedies with eye-popping value factors today. Simply final month, the drug Lenmeldy, a lifesaving gene remedy for a tragic childhood situation, set the present document for the very best drug value on this planet at $4.25 million. Earlier than Lenmeldy arrived, the hemophilia B drug Hemgenix held that document, with its value set at $3.5 million.
Whereas these superior therapies include mind-boggling costs, prescription drug prices within the US are an issue throughout the board. In a KFF ballot printed in August, 28 % of US adults reported issue affording their prescription medicine, whereas 31 % reported not taking their medication as prescribed up to now 12 months because of the price. A federal report from 2022 discovered that People pay practically thrice extra for prescribed drugs than folks in 33 different rich nations.