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Advice You - Medical Billing - The Weak Links
They say that any organization, project, idea, or anything is only as strong as its weakest link. That is no more true than in the world of medical
According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product
billing. The problem is, medical billing has so many weak links in its structure that it is a miracle that anything at all gets done. In this artic
; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.
Examples of combination products may in
Examples of combination products may in
e, we take a look at just a few of these potential disaster areas.
The biggest weak link in medical billing is the system itself. Oh, you can make
The biggest weak link in medical billing is the system itself. Oh, you can make
lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.
all the arguments you want about how they're doing the best that they can with a system that was doomed to fail from the start but it doesn't change
here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe
he fact that the medical billing process is a nightmare to begin with.
Let's start with the billers. Because of all the regulations, a ton of knowl
Let's start with the billers. Because of all the regulations, a ton of knowl
d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.
Combination pro
Combination pro
edge is needed in order to bill a claim correctly. The truth is, there's not really a lot of training for medical billing personnel. Most of it is
ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc
n the job training. As a result, a lot of mistakes are made. Now, in most businesses, when a mistake is made, it can be corrected quickly and no ha
easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi
rm done. But in medical billing, a mistake means a claim that goes out with the wrong or incomplete information. This results in the claim being de
nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically
ied. The claim then has to be corrected and resubmitted in order to be paid. While there are no hard and fast statistics on the number of claims th
and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ
at are billed incorrectly, it is estimated that it is somewhere in the area of about 10%. That means, theoretically speaking, each day the workload
ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi
ncreases by 10% because of claims that have to be resubmitted. This explains why there is such a backlog on claims that need to be paid. It's a nev
ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.
Following aspects would a
Following aspects would a
r-ending cycle, right out of the gate, that's never going to get any better.
Then there is the inefficiency of the people on the receiving end of th
Then there is the inefficiency of the people on the receiving end of th
dd to the challenges in developing combination products:
Which markets to tap where the combination products can do fairly well?
Which combination prod
Which markets to tap where the combination products can do fairly well?
Which combination prod
ese claims. Because the largest claim processors in the United States are from government agencies, these people are not really given the most incen
cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin
ive to do a fast job. So the claim processing process itself, by design, is very slow. This only compounds the problem. But the worst part of it i
tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen
What would be the developing cost?
How to tackle the risks encountered during combination product developmen
s, the claims that have to be resubmitted are given the lowest priority. This makes it even more critical that claims be submitted properly the firs
t?
As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel
As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel
time through.
Finally, as if the above two major problems weren't enough, you have the problem of poorly designed methods for doing the billing its
Finally, as if the above two major problems weren't enough, you have the problem of poorly designed methods for doing the billing its
ping new procedures for reviewing their safety, efficacy and quality.
Professional from academic institutions, pharmaceutical industries, health care indust
Professional from academic institutions, pharmaceutical industries, health care indust
elf. This can range from anything from badly designed software, of which there is plenty, to step by step procedures which are inefficient to say th
y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products
least. Plus, there is no standardization in the industry itself. Once upon a time, there was only one way to bill a claim. Now you have the stand
.
As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de
As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de
ard HCFA 1500 form, NSF 3.01 for electronic billing and UB-92 and other formats as well for the electronic transmission of claims. No two medical bi
elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.
Companies that provide selfless information through particip
Companies that provide selfless information through particip
ling companies do things the same way.
With so many weak links and many others not even mentioned, it's a miracle that this industry survives at all
With so many weak links and many others not even mentioned, it's a miracle that this industry survives at all
tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products
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