Category Archives: Industry Insights

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, […]

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. […]

The HCPCS Assignment Confusion What: Specialty Drug Webinar on HCPCS Codes When: Thursday, December 15th from 2:00 – 3:00 PM (EST) Join RJ Health Systems for our next and final webinar of 2016 focusing on HCPCS Codes and their creation and assignment. “Demystifying the HCPCS Creation Process and its Relationship with Drugs Coming to Market” […]

On the new ReimbursementCodes is a listing of the NEW HCPCS drug codes that become effective for Medicare billing for dates of service on or after January 1, 2017. It will not be a complete list of all 2017 HCPCS NEW Codes, but includes all codes for drugs that would appear on ReimbursementCodes. ReimbursementCodes is […]

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 […]

  What does it take to ensure sound reimbursement policies on physician administered drugs?  In a phrase, it takes “good data.” We, at RJ Health Systems, consider our data to be the industry standard for evaluating Medical drug reimbursement policy – a position we’ve earned over the past 16-years (average customer tenure is a whopping […]

RJ Health Systems was on the road over the last month attending AMCP and Asembia (formerly Armada) conferences, gaining insight into industry trends and interacting with our customers face to face. AMCP: At this year’s Academy of Managed Care Pharmacy (AMCP) Meeting in San Francisco from April 20th to 22nd, more than 4,200 managed care […]

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 […]