Medicare has been forced to expand its forms to accommodate 10-digit bills, which are just a penny shy of $100 million. This adjustment reflects the increasing financial burden that healthcare providers and payers face in processing claims for extremely high-priced therapies. The new system update in Medicare’s claims-processing system allows for higher-dollar amounts to be accurately processed and tracked, reflecting the rising costs of healthcare. While the change aims to ensure accurate and efficient provider reimbursement, critics express concerns about the potential for fraud and billing errors with the increased limit. Centers for Medicare & Medicaid Services (CMS) assures the public that measures are in place to monitor and prevent fraudulent activity. Overall, the change highlights the evolving healthcare landscape and the importance of adapting systems to address new challenges and complexities, particularly as healthcare costs increase.
CMS has faced challenges in accommodating the escalating costs of drugs and treatments in its claims processing systems, as reported by Stat news. In 2022, the agency encountered issues with chimeric antigen receptor (CAR) T-cell therapy claims, which can cost up to half a million dollars. The Multi-Carrier System (MCS) used by CMS had money amount fields limited to seven digits, posing a problem for processing these high-cost claims. To address this limitation, CMS advised doctors to split the bill by five or 10, depending on the size, and submit multiple claims to Medicare. This example underscores the need for continual updates and adjustments in healthcare systems to effectively manage the rising expenses associated with advanced treatments.
The high prices of advanced therapies like CAR T-cell therapy highlight the issue of escalating prescription drug costs in the United States. A KFF poll revealed that 28% of US adults struggle to afford their prescription medication, and 31% have not taken their medicine as prescribed in the past year due to cost concerns. According to a federal report from 2022, Americans pay almost three times more for prescription drugs compared to residents of 33 other affluent countries. This data underscores the widespread challenge of affordability and access to essential medications in the US healthcare system.