Category Archives: Educational Resources

Gain insight on how your organization can apply modest policy adjustments and some straight-forward network engagement tactics to achieve 6% to 10% in savings on Specialty Drug spend. Take the first step to improving medical drug management controls.

Clinical Drug data, which includes Min Max Dosing, Diagnosis Codes, and Age and Gender data, tends to be overlooked on medical drug claims. Health Plans will primarily analyze and review coding and pricing errors because they are directly connected to pricing and their bottom line. However, clinical errors on claim forms can be just as costly. […]

It has been 4 years since the last major update to the ICD-10-CM code set due to a partial code freeze. For the 2017 fiscal year (effective October 1, 2016 – September 30, 2017), there are now 71,486 ICD-10-CM codes and that includes 1,974 new codes, 425 revised codes and 311 deleted codes. ICD-10-CM codes […]

In the last Coding 101 blog that focused on HCPCS codes we discussed that there are 2 divisions of the code set into level I and level II. That focused on level II codes, in this blog we’ll discuss HCPCS Level I codes, also known as CPT® codes, short for Common Procedural Terminology. CPT® codes […]

Two weeks ago we officially announced RC Claim Assist, our provider facing NDC Conversion website. For those who may have missed it, RC Claim Assist is designed to help providers through the conversion process to ensure the correct HCPCS/CPT Code, NDC and NDC Units are submitted on a claim. This means a reduction in claim […]

During our discussions with clients we frequently receive questions on exactly what are HCPCS codes and how are they developed. In the coming weeks we will be sharing knowledge and insights on common customer questions. Today we’ll be discussing HCPCS codes. The acronym HCPCS (usually pronounced “hick-pick”) stands for Healthcare Common Procedure Coding System and […]

There is a growing trend in physician administered drugs submitted to the medical benefit. Billing at the NDC unit is becoming the new standard. While the use of an NDC has long been a requirement for many payors, it is becoming more prominent for physicians to now include the NDC Billable unit. After conducting a […]

RJ Health Systems’ most recent April 27th Specialty Pharmacy Webinar “Utilizing NDCs for Medical Benefit Drugs – A Payor’s Perspective” focused on improving drug data capture on Medical Drug Claims. The webinar described the limitations of the HCPCS model and the value of alternatively using the FDA assigned NDC for drug billing purposes. The webinar […]

What: Specialty Drug Webinar on Biosimilars When: February 17, 2016 from 2 – 3 PM (EST) Click Here to REGISTER NOW  – Seats are Limited! Join RJ Health Systems for the final in a series of two webinars focusing on Biosimilars and what effect they will have on the Specialty Drug Industry. “Biosimilars – Management […]

What: Specialty Drug Webinar on Biosimilars When: January 27, 2016 from 2 – 3 PM (EST) Click Here to REGISTER NOW  – Seats are Limited! Join RJ Health Systems for the first in a series of two webinars focusing on Biosimilars and what effect they will have on the Specialty Drug Industry. “Biosimilars – State […]