Main Subject - Business

When you are submitting a medical billing claim to an insurance carrier, probably the most important item as far as the carrier is concerned, is the item be

According to USFDA, a combination product is one composed of any combination of a drug and device; biological product and device; drug and biological product

ing billed. When all is said and done, that item is what is going to determine whether or not that claim gets paid. Why? Because even if an item is prove

; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

Examples of combination products may in

n to be needed by the patient, if it is prescribed by a doctor who is not authorized to dispense that item, the claim itself will still be denied. What doe

lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.

s this have to do with inventory files? Quite a lot, actually. In this installment we'll go over some basic things you will need to know when setting up y

here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe

ur inventory files.

The main part of every inventory item is the item description. Many medical billing personnel don't realize that this field is not ope

d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.

Combination pro

n to discussion. The item description MUST be the technical description as it appears in the Medicare, Medicaid, or private insurance manual. Even if one

ucts have become life saving products for the pharmaceutical companies who doesn’t have many innovative molecules in their product pipeline and have been inc

character is off, the claim will most likely not be paid. If this sounds nit picky, put a call into a US government medical agency and ask them if it's oka

easingly used in the product life cycle management. Even the companies having product patents are trying to extend their product life cycle through the combi

y to use abbreviations. The reply you get will be much less than amiable.

Then there is the matter of the serial number, in the case of rental items. Med

nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically

cal billing personnel can't seem to understand what the big deal is if a serial number is incorrect, or worse, missing. Well, try getting a claim file thro

and physically. They need to rightly judge the benefits of the combination products and they have to even look at the risks involved when combining the produ

ugh without one. Worse than that, try getting a replacement wheelchair when the one on the patient's property doesn't match the one that Medicare has in th

ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi

eir files.

What most billers don't know is that most DME inventory file formats contain fields to hold the modifiers for these serial items. The subject o

ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

Following aspects would a

f modifiers will be covered in detail in a future article. For now, what you need to know is that when a rental item is billed, not just the first month, b

dd to the challenges in developing combination products:

Which markets to tap where the combination products can do fairly well?
Which combination prod

t for every month thereafter, these modifiers are updated and restored in the file. If the modifiers don't pull correctly, or worse, don't even store in th

cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin

e first place, then the claim will be denied because of missing modifiers.

Your medical billing procedure gets even more complicated when billing items tha

tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen

t are not in individual units, such as when you're billing something that's either in a box or a case. What does this have to do with inventory? Well, mos

t?

As combination products don't fit into the traditional categories of drugs, medical devices, or biological products, the USFDA is in the process of devel

t DME inventory files have what is called an item type field, which designates whether the item is a single item, box item of case item. A case item is an

ping new procedures for reviewing their safety, efficacy and quality.

Professional from academic institutions, pharmaceutical industries, health care indust

tem that contains multiple boxes. When you submit your bill, if it is for one of the item types that is not a single item, the software has to go through a

y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products

conversion because most medical billing carriers require all bills to be submitted in units. The subject of conversion will be covered in more detail in a

.

As there is an increasing trend of the combination products companies manufacturing such products should be able to tackle the problems involved in the de

nother installment. All this information, however, has to be stored in the inventory file.

And this only scratches the surface. Inventory files are quite

elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.

Companies that provide selfless information through particip

complex and a large percentage of what goes into a medical bill depends on these files. So it is critical that you make sure that they are setup correctly

tion in industry events and feedback to regulatory authorities would be able to face the challenges and will be successful in developing combination products

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