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In this installment of medical billing and the DME software setup, we're going to briefly cover what is involved with the setup that is specifica

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

lly designated for the people who do the actual billing of claims. This is a very complex process that involves a number of items that all have

; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

Examples of combination products may in

o work together.

In order to bill an insurance carrier for a claim, there are a number of items that the biller needs access to. This includes

lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.

the patient personal information, the item being billed, the carrier the bill is sent to and the method by which the bill will be sent. In order

here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe

for this to happen, these things have to be setup in the system for the biller.

The first order of business is that the biller needs to have pat

d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.

Combination pro

ient access. When the bill comes in, the patient number is usually on the first page of the bill. This number should have then been entered int

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

the system along with the patient information. The biller will then have access to this information through what is called a patient lookup fea

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

ture. These features usually have several fields by which the biller can lookup the patient, such as by last name, ID number, etc.

After the pa

nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically

ient is found, the next thing the biller needs to know is what the item is being billed. These items all have to be setup in inventory, which is

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

usually done by the inventory manager. Another lookup function is then provided to the biller for looking up inventory items. This is usually

ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi

one by item name or sku number. Once the item is found in inventory, the item is then added to the billing sheet.

The next thing that the bille

ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

Following aspects would a

needs is the carrier that is going to be billed and the method by which the bill will be sent. The carrier is usually attached to the patient w

dd to the challenges in developing combination products:

Which markets to tap where the combination products can do fairly well?
Which combination prod

hen the patient file is setup. But in some cases, the insurance carrier is not known at the time and the biller has to add it at the time of bil

cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin

ing. For this, another lookup table is provided with all the insurance carriers that the system supports. These are usually updated on a regula

tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen

r basis. The way the biller knows which carrier to pull is by looking at the billing sheet that came in. The carrier is listed there.

The meth

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

d by which the bill itself will be sent is usually determined by the billing agency itself. Not all agencies have electronic billing capabilitie

ping new procedures for reviewing their safety, efficacy and quality.

Professional from academic institutions, pharmaceutical industries, health care indust

s. In the cases where such capability doesn't exist, the default billing method will be via paper claims and the biller won't have to do anythin

y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products

. The claim will automatically go to the print que upon submission.

Naturally, the above process is greatly simplified, but for the most part,

.

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

that is all that is involved with sending a bill for a medical claim. The truth is, if medical billing was this easy, there wouldn't be so many

elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.

Companies that provide selfless information through particip

laims that get denied each day. The problem is that billers are not properly trained and the medical billing software itself can only do so much

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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