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Main Subject - The Long and Winding Road of Medical Billing
Medical billing is a multi-million dollar industry in America today. The exact process a bill goes through varies widely de
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
pending on various factors, such as the type of insurance a patient has and the type of service rendered by a provider.
Th
Th
; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.
Examples of combination products may in
Examples of combination products may in
process begins after a patient has a doctor visit, which could include actual treatment for injuries or other medical cond
lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.
tions. Sometimes the visit may simply be a diagnosis of a condition leading to a prescription given by a doctor. After the
here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe
isit has concluded, a doctor will give details of the visit to a medical specialist of some sort. This specialist will fill
d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.
Combination pro
Combination pro
out a billing record with more technical information regarding the visit, such as codes representing different diagnoses. T
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
e billing record is then sent to the insurance company, or sometimes to an intermediate firm that will process the record b
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
forehand. Either way, the billing record will get processed and analyzed to make a determination on which charges the insur
nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically
nce company pays for. The insurance coverage of a patient may not actually cover all the costs of the services the provider
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
has included in a billing record.
Once the insurance company or some other intermediate organization has finished processi
Once the insurance company or some other intermediate organization has finished processi
ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi
g the claim, deciding which costs it will cover and which ones the patient has the responsibility to pay, an explanation of
ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.
Following aspects would a
Following aspects would a
benefits (EOB) is returned to the original provider of the medical service. Once the provider gets the EOB, the information
dd to the challenges in developing combination products:
Which markets to tap where the combination products can do fairly well?
Which combination prod
Which markets to tap where the combination products can do fairly well?
Which combination prod
and coding will need to be deciphered. The insurance company might possibly have agreed to pay for all the charges the prov
cts are meaningful and rational?
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin
Which therapeutic categories to select?
Which Combinations can address unmet needs of the patients?
Do combin
der listed on the bill. If so, the insurance provider pays on behalf of the patient.
However, insurance companies rarely c
However, insurance companies rarely c
tions increase the patient compliance?
What would be the developing cost?
How to tackle the risks encountered during combination product developmen
What would be the developing cost?
How to tackle the risks encountered during combination product developmen
ver all the costs a medical provider has listed on the bill. Usually one or more of the charges will be determined by the i
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
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
surance company to be the responsibility of the patient. If the insurance company rejects charges the medical provider has
ping new procedures for reviewing their safety, efficacy and quality.
Professional from academic institutions, pharmaceutical industries, health care indust
Professional from academic institutions, pharmaceutical industries, health care indust
isted, the provider must make changes to the claim and resubmit it to the insurance company. Once resubmitted the insurance
y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products
company will look at it again to see if the information is accurate, and to determine whether it will pay the reduced charg
.
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
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
s the provider has listed.
Eventually, perhaps after several repetitions of this medical billing process, the claim will b
Eventually, perhaps after several repetitions of this medical billing process, the claim will b
elopment. They need to be wiser in analyzing the market trends and the regulatory requirements.
Companies that provide selfless information through particip
Companies that provide selfless information through particip
accepted by the insurance company and it will pay for its portion of the charges, while the patient pays for the remainder
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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