Author Archives: Doug Horn

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 […]

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 […]

Consider that the average cost for a medically covered drug is +$200 (Client Claims data). Errors associated with the processing of these claims have significant implications. Data quality must be monitored and updated into processes and systems to avoid these risks. This is compounded by the challenge of infrequent updates to the pricing methodology or […]

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 […]

Control your Medical Drug Spend.  Learn about medical benefit drug pricing trends. Webinar: Addressing Escalating Medical Benefit Drug Pricing In this new webinar, Addressing Escalating Medical Benefit Drug Pricing, we will break down topics like: How to identify price trends for medically billed drugs and the reasons behind those trends. How to identify the top drug […]