Advice You - Business

Arcane terminology and complex rules for payer- and time-dependent claim validity and pricing interpretation plague medical billing industry, resulting in massive payments of invalid or ineligible claims and denials of error

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

-free claims. The amount and complexity of billing information make it very difficult for the doctor to maintain compliance and identify and resolve errors and underpayments.

"With integrated Billing Transparency, I see for

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

Examples of combination products may in

myself how Vericle leverages every opportunity to expedite payments of healthcare insurance claims in a continuous 24 x 7 effort. It has enabled 27% revenue gain over past billing process," says Doug Cassel, M.D., Director

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

of Interventional Radiology at Hoag Memorial Hospital in Newport Beach, California.

Greater visibility of internal process activities promotes teamwork, increases client satisfaction, and assists in process streamlining. B

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

illing service transparency allows participants of the billing process to expedite error identification and resolution, resulting in reduced over- and under-payments and improved regulatory compliance.

1. Billing Dashbo

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

Combination pro

ard as Main Transparency Mechanism

Selection of meaningful and intuitive indicators for billing process performance is a mission-critical stage in the process of creating a useful transparency mechanism. A dashboard p

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

resenting such most meaningful data must be easy to find and simple for interpretation. Cumulative experience of hundreds of doctors using Vericle-like billing technologies, has shown that a dashboard containing nine specif

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

c indicators expedite the development of intuitive and powerful transparency mechanisms:

Month-to-date collections
Total failed or denied claims
Aggregate failed or denied cl

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

aims in follow-up queue

Dollar Accounts Receivable (AR) below 30 days,

$ AR in ( 30, 120] days

$ AR > 120 days

Percent Accounts Receivable (AR) below 30 days,

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

% AR in ( 30, 120] days,

% AR > 120 days

Note that national average of percent accounts receivable above 120 days hovers around 18%. Therefore, a well-performing outsourced billing service must

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

deliver % AR > 120 days significantly below 18%. Specifically, to justify its fees, an outsourced billing service must measure its AR > 120 days anywhere around 5%.

2. Drill-down Functionality, Reporting, and Transpare

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

Following aspects would a

ncy

Advanced dashboard allows drill-down for more detail directly by pointing and clicking the cursor at the dashboard. At the minimum, the following features must be available:

Operational Report
dd to the challenges in developing combination products:

Which markets to tap where the combination products can do fairly well?
Which combination prod
> shows total claims and $ amounts submitted, paid, adjusted, written off, and failed. It allows breakdown by CPT code, payer, referral, or a combination of such dimensions.

Denials Report shows the li

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

st of denied claims and a log of followup actions. By sorting it by amount paid, you can tell the smallest payment the billing service will fight for.

Compliance Report shows the potential for post-pay

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

ent audit and itemizes compliance violations.

These reports allow multiple dimensions for data presentation, by single parameter, such as, payer, CPT code, provider, or referring physician, or by more complex p

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

arameter combinations, such as pairs of payer-CPT code, provider-CPT code, or referring physician-CPT code.

3. Complexity Considerations

Note that even a small single-provider practice working with 20 CPT codes an

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

Professional from academic institutions, pharmaceutical industries, health care indust

d 20 payers, has 400 (20x20) payer-CPT code pairs. Therefore, an on-line report comparing month-to-date collections between current and previous years requires powerful database query capability. Moreover, automation of su

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

ch queries like "find the worst performing payer for the best performing CPT code" requires OLAP technology.

4. Summary

Billing Transparency is a necessary feature of a modern and accountable billing service. Bil

.

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

ling Transparency allows the practice owner to know both the big picture and minute detail of billing process. To be able to observe every step of the billing process on a continuous 24 x 7 basis, reporting must be availabl

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

Companies that provide selfless information through particip

e using a secure HIPAA compliant connection over the Internet. While traditional services delivered monthly paper reports, modern technology allows the delivery of continuously updated and meaningful billing performance data

tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products

Tags

Links

Advice You - Electronic Medical Billing Dashboard Software - 9 Performance Indicators For Service Outsourcing

Related Articles: