In a disturbing signal of the instances, Medicare this week applied a change to its claims-processing system that provides two additional 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/therapies exceeding the $999,999.99 limitation, CMS is implementing the enlargement 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’ places of work to course of Medicare claims.
Stat information, which first reported the replace, famous that it is not the primary time CMS has struggled to make room for ever-increasing drug and remedy costs in its claims processing programs. 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-Provider System (MCS), the cash quantity fields solely included seven digits. In that case, quite 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 therapies with eye-popping value factors lately. Simply final month, the drug Lenmeldy, a lifesaving gene remedy for a tragic childhood situation, set the present file for the best drug value on the planet at $4.25 million. Earlier than Lenmeldy arrived, the hemophilia B drug Hemgenix held that file, 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 p.c of US adults reported issue affording their prescription remedy, whereas 31 p.c reported not taking their drugs as prescribed up to now 12 months because of the value. A federal report from 2022 discovered that People pay almost 3 times extra for pharmaceuticals than individuals in 33 different rich nations.
