Category Archives: Educational Resources

Where will tildrakizumab be positioned in the psoriasis marketplace once approved by the FDA? Plaque psoriasis (psoriasis vulgaris) (ICD-10 L40.0), which is commonly referred to simply as psoriasis, is the most common form of the skin disease with a prevalence of 2-3% worldwide.  GlobalData estimates that the biologics total drug sales for psoriasis in 2012 […]

Review of ibalizumab-uiyk (TrogarzoTM) a novel biologic for patients with multi-drug resistant HIV-1 Multi-drug resistant HIV (MDR-HIV) carries a greater risk of disease progression and leaves HIV patients with limited treatment options. There are currently 10,000 people living with MDR-HIV in the United States, and due to this prevalence, it has become necessary to consider drug […]

RJHS – Drug Alert FDA Drug Approval – Ibalizumab-uiyk (TrogarzoTM) On March 6, 2018, the U.S. Food and Drug Administration (FDA) approved a first in class treatment for adults with multi-drug resistant (MDR) HIV-1 infection, with a manufacturer’s initial estimated annual treatment cost of $118,000. An initial overview is listed below.  For additional Information on […]

Setting limits: What’s good for your waist may also be good for your (brown/white bagging) waste. It’s a new year! While packing my lunch these days, I find myself setting better limits.  In an attempt to prevent waist expansion, I check off my limits: 30 grams carbohydrate from grains 20 from fruit a fat limit […]

Did you know : that healthcare fraud estimates in the United States exceed $68 billion annually? Did you know : the Federal Government won or negotiated over $2.5 billion in health care fraud judgments and settlements worth a total of over $1.9 billion in FY 2015? Did you know : that when differentiating fraud from waste and abuse, the […]

Gain insight on how your organization can apply modest policy adjustments and some straight-forward network engagement tactics to achieve 6% to 10% in savings on Specialty Drug spend. Take the first step to improving medical drug management controls.

Clinical Drug data, which includes Min Max Dosing, Diagnosis Codes, and Age and Gender data, tends to be overlooked on medical drug claims. Health Plans will primarily analyze and review coding and pricing errors because they are directly connected to pricing and their bottom line. However, clinical errors on claim forms can be just as costly. […]

It has been 4 years since the last major update to the ICD-10-CM code set due to a partial code freeze. For the 2017 fiscal year (effective October 1, 2016 – September 30, 2017), there are now 71,486 ICD-10-CM codes and that includes 1,974 new codes, 425 revised codes and 311 deleted codes. ICD-10-CM codes […]

In the last Coding 101 blog that focused on HCPCS codes we discussed that there are 2 divisions of the code set into level I and level II. That focused on level II codes, in this blog we’ll discuss HCPCS Level I codes, also known as CPT® codes, short for Common Procedural Terminology. CPT® codes […]

Two weeks ago we officially announced RC Claim Assist, our provider facing NDC Conversion website. For those who may have missed it, RC Claim Assist is designed to help providers through the conversion process to ensure the correct HCPCS/CPT Code, NDC and NDC Units are submitted on a claim. This means a reduction in claim […]