Author Archives: Doug Horn

Increasing healthcare costs continue to outpace inflation in the United States. Specialty drug costs are the largest driver and component to healthcare spend. This surge has led to transformative patent care but has also given rise to a disproportionate total healthcare spend. Major drivers of medical drug spend are the complex processing of medical drug […]

Beginning Tuesday, March 26th and through Thursday, March 28th, the AMCP Managed Care & Specialty Pharmacy Annual Meeting will be taking place at the San Diego Convention Center. Featuring symposia, workshops, pipeline sessions, educational sessions, and many more events crucial to the specialty pharmacy industry. RJ Health will be at booth 711, exhibiting its tools to […]

  The pace of advancement in genetics and precision medicine is staggering. Today, there are more than 75,000 genetic testing products on the market, and more than ⅓ of therapies in the development pipeline are for molecularly-defined conditions. In this webinar, experts in genetic testing, drug spend, and claims payment automation will provide practical insight […]

  Below is the transcript from our On-Demand Micro-Webinar: Where is my NDC? Powered by ReimbursementCodes.com Laura:  Welcome, and good day.  Thanks for joining us.  Today we would like to help you by answering the most frequently asked question about RJ Health Data; Where is my NDC? I’m Laura, Clinical Informatics  Pharmacists with RJ Health, and joining […]

There are several instances where dosing NDC and HCPCS code units don’t agree. Pay special attention when billing for a pediatric dose, that the NDC is billed under the pediatric code if one exists. Each dose has a different NDC unit, and they cross back to the single HCPCS value. If billed under the wrong […]

Whether the product comes in a single or multi-dose vile can also affect billing units. In this example, there is one billing unit contained in a single-dose vial, and 10 billing-units are contained in a multi-dose vial. In this case, it is helpful that the NDCs cross-walk back to different codes. Conversion factors are often incorporated […]

You have to take into account multiple considerations based on the NDC that is being billed, such as the dose for a pediatric patient billed differently from an adult dose, so each may crosswalk to a unique code. Whether the NDC designates a single dose or a multi-dose vile could affect the unit conversion.   […]

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 […]

Over the last five years we have mapped over 520 vaccine NDCs to over to over 130 vaccine billing codes. Several of these codes cover just this year’s flu vaccines alone. Codes for flu vaccines are updated every year due to new code approval process: This segment is from RJ Health’s On-Demand Webinar: Vaccine Coding Challenges […]

  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 […]