Patients across New England, especially seniors living on fixed incomes, are feeling the squeeze of rising health‑care costs. While many factors drive inflation, waste hidden in routine billing practices offers a concrete way to lower expenses for everyday residents.

How duplicate billing inflates costs

Providers use complex billing codes to charge insurers for each service rendered. When a patient receives two services during a single visit—such as an evaluation and a procedure—the current rules often allow both to be billed at full rates. This means Medicare and Medicaid pay twice for many of the same underlying costs, inflating the bill for patients and wasting taxpayer dollars.

CMS’s proposed fix

The Centers for Medicare and Medicaid Services (CMS) is proposing a rule that would change this practice. Under the new guidance, if an evaluation and a procedure occur on the same day, Medicare would pay the full price of the more expensive service and a reduced rate for the second. The adjustment reflects the shared resources between the two services and stops the government from overpaying.

Impact on seniors

A routine visit can cost more than $235 for the evaluation and management fee alone, with patients responsible for nearly $50 under the standard Part B co‑insurance. Adding the cost of a procedure on top of that can make the visit unaffordable for many older adults. Recent studies show a majority of seniors live on less than $2,000 per month, and nearly 60% have skipped essential medical services in the past year because of cost.

Why the rule matters

By addressing duplicative billing, the proposal targets a specific source of waste that directly affects Medicare beneficiaries in New England. Reducing unnecessary payments can help lower overall health‑care spending, keeping more money in the hands of families and preserving taxpayer resources.

Calls for action

Advocates, including Dr. Haley Director, policy director of Rare New England, urge CMS to move forward with the rule. They argue that eliminating duplicate billing is a critical step toward making health‑care more affordable for seniors and for all New Englanders.

As the Trump administration continues to prioritize fiscal responsibility and efficient government, this CMS initiative aligns with broader efforts to reduce waste and protect families from rising health‑care costs.

Original reporting: The Connecticut Mirror — read the source article.