Author Archives: RJ Health

RJ Health’s Chris Webb and Jason young walk through the different categories of specialty drug prices, and what is required for reimbursement with each. These webinar clips from “Shedding Light on Medically Covered Specialty Drug Pricing Methods” touch upon AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), ASP (Average Sales Price), and how they are […]

$35 billion of drug-related revenue comes from healthcare provider offices. Health plans have established policies that require additional information, not just the HCPCS code. This additional information enables payors to differentiate between drugs that exist under the same billing codes. Recent claims analysis revealed a high degree of confusion from providers on what is required […]

The following questions were submitted by attendees during the most recent Quarterly Drug Coding, Reimbursement, and Pipeline Update Webinar for Q3 2019. or      Q:  On the “Pricing Updates” slide it shows that the majority of Code Price changes were increases, but the Medicare Allowable ASP price changes showed a majority which were decreases. Why […]

Join RJ’s Jason Young – SVP Clinical Data Operations, Todd Cooperman – SVP Clinical Insights and Analytics, and Chris Webb – Director of Product Development, as they review the drug coding updates, revisions, and issues observed over 2019’s third quarter. Learn about: New and Existing Code Updates – HCPCS Codes: J Codes, Q Codes •  […]

Wondering about the different types of HCPCS (Healthcare Common Procedure Coding System) codes and how they apply to reimbursement? Chris and Jason walk through HCPCS and CPT® (Current Procedural Terminology) code background in this edition of Drug Pricing and Reimbursement 101. These webinar clips from “Shedding Light on Medically Covered Specialty Drug Pricing Methods” touch […]

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 on Medically Covered Specialty Drug Pricing Methods.” In the following clip, Chris Webb explains the application and breakdown of the NDC or National Drug Code. All past […]

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 […]

Beginning April 29 and continuing to May 2, Asembia will be hosting its 15th annual Specialty Pharmacy Summit at Wynn & Encore in Las Vegas. RJ Health is excited to join the many pharmacies, health systems, pharmaceutical manufacturers, PBMs, health plans, technology companies, and consulting firms that will be in attendance. The agenda includes continued […]

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 […]