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Medical billing complexity and massive volumes of daily claims render manual claims processes incapable of protecting both the provider and the payer from underpayments, overpayments, and billing compliance violations. Straight T

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

hrough Billing addresses complexity and volume processing problems by automating the majority of the claim flow and focusing the billing follow-up specialists to exceptions only. A Straight Through Billing process flags problems,

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

Examples of combination products may in

routes them for follow up, and enables online correction and resubmission. Straight Through Billing methodology implements billing service transparency and focuses management on strategic process improvement opportunities.

Stra

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

ght Through Billing (STB) integrates billing process within the practice management workflow, automates vast majority of transactions, focuses manual labor on exceptions, and establishes a process for continuous improvement.

Firs

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

t, integrated practice management and billing workflow connects patient scheduling, medical record management, and billing into a single flow. Every participant of the practice management workflow receives a unified and coherent p

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

Combination pro

cture of practice workload, patient and provider location, resource availability, and cash flow.

Next, transaction automation streamlines and expedites billing process by automating claim validation, payer message reconciliation,

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

and billing workflow management:

Automated claim validation eliminates errors downstream and reduces processing time because it flags errors before submitting the claim to payer.
Automated claim-message re

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

conciliation eliminates costly search for the original claim and standardizes message communication, further eliminating the need to decipher the (often cryptic) payer's message.

Billing workflow management drives the

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

ollowup discipline required for resolution of claim denial and underpayment incidents and establishes high degree of process transparency for all billing process participants, resulting in full and timely payments.

T

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

hird, focusing manual labor to exceptions requires timely exception identification, routing to followup personnel, online error correction, and rigorous followup tracking. Again, process transparency, as implemented in vericle-li

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

e systems, enables tracking exception followup.

Finally, a process for continuous improvement requires continuous observability of every process attribute and a modification methodology for both automated claim processing and man

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

Following aspects would a

ual exception followup tracking.

STB implements billing transparency by design because billing transparency is an integral attribute of every component of STB process.

Straight Through Billing Architecture

Straight Thr

dd to the challenges in developing combination products:

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

ough Billing systems architecture mirrors the architecture of general Straight Through Processing (STP) systems developed for the financial services industry. Such systems require effective workflow management, knowledge base va

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

idation system, connectivity to all process participants, including on-line data reconciliation, and tracking of problem resolution. Therefore, a typical vericle-like STB system has a three-tier architecture:

Back-en

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

d processing engine designed for high-volume transaction processing environment

Middle-tier uses Java Servlet technology

Front-end is an HTML-JavaScript zero-footprint client

An STB system (e

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

g., Vericle) following the methodology outlined above implements rich functionality, which allows automated

Computer aided preferential patient scheduling
Integrated electronic medical records
O

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

Professional from academic institutions, pharmaceutical industries, health care indust

n-line computer aided coding

Real-time claim validation and patient eligibility testing

Electronic claim submission

Payment posting, reconciliation, and verification of meeting contractual oblig

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

ations

Monitoring of audit risk and billing compliance

Tracking of denial appeal process

Quantitative STB Management

STB methodology allows for quantitative management as the likelih

.

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

od of failure of the entire process can be estimated as the product of such items for each individual workflow steps. A vericle-like STB system tracks the percent of clean claims (claims paid without any manual intervention in fu

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

Companies that provide selfless information through particip

ll and within the allocated timeframe) and focuses the management on those process aspects that yield the greatest potential improvement. Thus STB methodology focuses on exceptions both at tactical and strategic management levels

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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