Category Archives: Webinar

When we are dealing with code level data, important basics include the billing of the correct units and making sure that you are billing under the correct code. For this year, seven brands of quadrivalent vaccines are available, but due to different properties including dose, 28 individual NDCs crosswalked back to 9 different codes.   This […]

Hello. I am Wendy Sullivan, Director of Drug Informatics for RJ Health. I’d like to welcome you to today’s webinar-Creating Pre-Payment Controls for Medically Covered Drug Costs through Automation. Before we get started, I’d like to thank you for attending and to thank my colleagues who helped make this webinar possible. In terms of my […]

  Below is the transcript from our On-Demand Micro-Webinar: Vaccine Coding Challenges Powered by ReimbursementCodes.com Laura:    Good day, welcome, and thanks for joining us. Today we’d like to help you by providing a quick brush up on vaccine coding. I’m Laura, Clinical Informatics Pharmacist for RJ Health, and joining me today is Chris Webb who is our […]

Each year there are dozens of new drugs (56 in 2018) and new CMS HCPCS assignments (38 in January 2018), as well as hundreds of new indications approved. This is in addition to the ongoing updates in coding assignments, pricing, generic entries and more. Consider that the average cost for a medically covered drug is […]

Many medically covered drugs are costly, and processing errors can have significant implications. By 2020, it is estimated that more than half of specialty drug claim costs will be submitted through the medical benefit. Join Wendy Sullivan, Director of Data Informatics, on October 11th, 2pm EST, as she walks through the common issues and solutions […]

Appropriate reimbursement for drugs covered by the medical benefit requires more data and structure than most medical claims or billing systems were originally intended to process. This applies even more so when the systems are proprietary. The tendency to solve this issue has been to apply headcount (ex- case workers & analysts), continually enhance existing […]

Medically covered drug pricing is highly sensitive, and changes occur frequently. The more variability in a system, the greater the chance for errors and inefficiencies. Regarding price methodologies, most reimbursements are based on CMS’ Average Sales Price (ASP) and/or Manufacturers’ Average Wholesale Price (AWP). This should be straightforward. However, payments, driven by a coding process […]

Each year there are dozens of new drugs (56 in 2018) and new CMS HCPCS assignments (38 in January 2018), as well as hundreds of new indications approved. This is in addition to the ongoing updates in coding assignments, pricing, generic entries and more. Consider that the average cost for a medically covered drug is […]

NDC mandates have been in place for Medicaid covered lives for over a decade. In recent years, this requirement has been expanded to account for additional lines of business. This shift creates a larger member population which in turn creates new claim volume. The addition of the volume mixed with the requirement for electronic claim […]

INSIDE THIS ISSUE Code Updates: Large Price Changes Reminder – NEW HCPCS Q-Codes effective July 1, 2018  CMS NEWS: April 1, 2018 NOC Pricing File Updated Drug Reimbursement Code Price Updates  Drugs/Devices: New Clinical and Billing Information New Webinar: Shedding Light on Medically Covered Specialty Drug Pricing Methods Let’s discuss Specialty Drug Pricing Methods… WAC. […]