Main Subject - Business

Processes involving large volumes of complex billing transactions require effective mechanisms for problem assignment and tracking. Without such mechanisms, billing personnel cannot be held accountable for problem resolution, resulting in loss of revenue and inc

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

reased compliance risk. While medical billing industry has developed specialized systems and processes for resolution of content problems, little attention has been paid to billing process problem resolution methodology. This article outlines a process and a te

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

Examples of combination products may in

chnology for integrated billing process problem resolution methodology.

Billing Content and Process Problems Require Two Different Tracking Methodologies

Medical billing exceptions can be categorized into content and process problems. Content problems

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

have to do with claim content and patterns of processed claims, such as terminology, medical necessity, patient eligibility, denial followup, and regulatory billing compliance. Process problems have to do with claim formatting, system interfaces, entry of patie

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

nt demographics, posting of charges and payments, printing and mailing or faxing of required information, provider interaction procedure, systems access, and HIPAA compliance.

While streamlining and transparency are important attributes for resolution of both ki

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

Combination pro

ds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems,

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

tend to cover a wide variety of knowledge domains, precluding specialization.

The difference in solution methodology drives the difference in problem tracking. For content problem resolution methodology the reader is advised to consult companion articles on me

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

trics, straight through billing, and billing transparency. The remainder of this article focuses on process problem tracking.

Billing Process Problem Tracking

A general-purpose tracking system allows opening problem ticket, its assignment to specific

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

team member, its re-assignment or escalation, change of status depending on problem resolution stage, convenient reporting about sets of tickets in different states or assigned to different team members, and continuous notification of everybody involved about cha

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

nge of status. Therefore, such a tracking system (e.g., web-based TrackLogix) is constructed around three basic reports, notification mechanism, and a concept of ticket.

Problem Tracking Reports

The reports show

Tickets I owe to others
ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi
i>
Tickets owed to me
Status - a summary table of the team participants with statistics of tickets in different states

Other reports may show and compare individual productivity and responsiveness.

Problem Notification

F

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

Following aspects would a

or transparency, the members of the team must be continuously aware of every problem resolution status. The simplest way to maintain such awareness is to send an email to every team member about every event of problem ticket status change. Other popular notific

dd to the challenges in developing combination products:

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

ation media include paging and SMS calls. More sophisticated methods involve selective notification based on nature of event or person assigned to problem resolution.

Problem Ticket

The ticket has the following data elements:

Subject - sh

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

ort description of problem

Owner - name of the employee responsible for issue resolution

Requestor - name of the manager that assigned the issue to the employee

Date - date the issue was identified and documented

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

Scheduled - date (time) this issue must be resolved

Body - a detailed issue description

Log - time-and owner-stamped history of all documentation, including

Escalation. Issues may be escalated to upper management via

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

rackLogix by simply changing the Owner

Priority change

Status change

Date change

Owner change

Specific action taken to resolve the issue

Priority - relative issue importance or

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

Professional from academic institutions, pharmaceutical industries, health care indust

der among other issues on the same workbench.

Status

Open for new issue
Pending for resolved and waiting for approval
Closed for resolved and approved

Vericle-like Straight Thro

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

ugh Billing (STB) systems automate majority of billing transactions and focus manual followup on exceptions. A formal web-based process problem tracking system, such as TrackLogix, provides accountability,

.

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

which is based on a precise account of all process problems and their resolution status. With such a tracking system, every process participant has visibility to other problems. An increased level of personal accountability promotes teamwork, increases client s

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

Companies that provide selfless information through particip

atisfaction, and assists in streamlining the process.

For more information about problem resolution transparency and its four attributes, including universality, continuity, ubiquity, and scalability, read our companion article about medical billing transparency

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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Is it possible to fix service problems from just one vantage point, say just by training your employees in customer service skills? Or does it require a more holistic approach that looks at all the points of entry into your organization such as hiring, vendor relationships and more?

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