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In June there were four new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were 12 supplemental drug approvals. The FDA had acted on assignment of six new product reviews. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include anticipated […]

INSIDE THIS ISSUE CMS News New, Revised, and Deleted HCPCS® Effective July 1, 2019 Quarterly ASP (Average Sales Price) Pricing File Released Hospital OPPS (Outpatient Prospective Payment System) Update Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Data Enhancements Coming Soon CODE UPDATES Large Price Changes: We identify and report […]

Many payors have incorporated policies for providers to inform payors on discarded or wastage amounts of drugs in single-use packages. To ensure appropriate reimbursement, the providers are required to submit two claim lines for the administered drug.  One claim line reflects the dosage administered to the patient and the second is for the wastage amount. […]

  Is your organization ready to recapture some of the $3 Billion lost each year to drug wastage? Have single-dose vials, dose, and waste, created a reimbursement challenge? What is drug wastage? How does drug wastage occur? What is the size and scope of drug wastage? Who does drug wastage impact? How can drug wastage be addressed? […]

INSIDE THIS ISSUE CMS News New, Revised, and Deleted HCPCS® Effective July 1, 2019 Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Data Enhancements Coming Soon CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or decreases each month and detail […]

In May there were three new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were 14 supplemental drug approvals. The FDA had acted on assignment of three new product reviews, although no PDUFA dates were published. Drugs included in this review are generally regarded by the industry as […]

Below is the transcript and demo from our on-demand MicroWebinar:  Road Testing the RJ Health Medical Drug Edits and API Platform RJ Health’s MDEs intake customer claim data and apply our best in class medically covered drug data and algorithms in order to improve reimbursement timeliness, drug coding, and payment accuracy, drug formulary adherence, and […]

INSIDE THIS ISSUE CMS News New, Revised, and Deleted HCPCS® Effective July 1, 2019 Upcoming in the June Update Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Data Enhancements Coming Soon CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or […]

In April there were four new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were five supplemental drug approvals. The FDA had acted on assignment of new PDUFA dates for six new products for review. Drugs included in this review are generally regarded by the industry as specialty […]

In Medical Drug Edit Blog Posts #1 & #2, we learned how Medical Drug Edits can enhance Medical Drug claim submission and reimbursement accuracy.  However, the utilization of an API (Application Programming Interface) to deliver Medical Drug Edits can further improve the Medical Drug pre-claim review process. Specifically, the use of an API can: Speed […]