Tag Archives: provider

Have questions about how drugs are priced? Wondering which pricing methodologies apply to your drug claim? Curious about the origins of the various types of drug codes? Join RJ’s Product and Clinical teams as they walk through the multitude of different combinations of drug claims and pricing methodologies, via clips from the webinar “Shedding Light […]

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? […]

Our latest white paper demonstrates the value and versatility of an automated medical drug claim edits solution. RJ Health’s system implements a rules-driven platform to reduce overall medical drug claims errors and improve overall efficiency. Appropriate reimbursement for drugs covered by the medical benefit increasingly requires more data and structure. Many of the billing systems […]

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 […]

In Medical Drug Edit Blog Post #1, we saw that pre-payment edits of Medical Drug claims can be utilized to improve claim submission and reimbursement accuracy.  Payors and providers license RJ Health’s Medical Drug Edits and access them via our API platform. This is because effective pre-payment review of medical drug claims requires: •  The […]

Drugs covered under medical benefit plans and their costs are difficult to manage. These challenges are due to: •  Limited clinical visibility and control •  Unaccommodating medical claims and claim systems •  Complex billing and reimbursement requirements related to coding and pricing As a result, medically covered drug claim errors are almost the norm.  In […]

  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 […]

A running theme at the Asembia 2017 Specialty Pharmacy Summit was the explosive growth in attendance from several hundred a few years ago to greater than 6,000 in attendance in 2017.  Pharmaceutical and Biological (Pharma/Bio) manufacturers were the dominant presence at Asembia, which is no surprise given their pricing power in the specialty drug market, […]