Main Subject - Business

Benchmark-driven performance management helps establish objective industry standards. Medical service providers can use benchmarking to evaluate performance

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

of their billing service and measure their improvement over time. This article presents a prototype for a rule-based chiropractic index, including its covera

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

Examples of combination products may in

e definition, update cycle, volume weighting, and provided information.

Current (June 2006) Billing Precision Index (BPI) stands at 18, which means that the

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

average of ten top performing payers working with BPI clients have 18% of Accounts Receivable beyond 120 days. This is a key billing performance characterist

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

c, as it is a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the t

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

Combination pro

p ten performing payers and their relative index as recorded in Billing Precision's system ( BillingP

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

recision.com ).

Billing Precision Index 18
Benesight 5
Blue Cros

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

Blue Shield Florida 5

Medicare Florida 7

United Health Care 8

Oxford

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

Cigna 13

Medicare New Jersey 17

Horizon

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

Aetna 21

Blue Cross Blue Shield Texas 33

Coverage

BPI

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

s rule-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers

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

Following aspects would a

. Therefore, any specific payer may start or discontinue participation in the index, dependent on satisfaction of rule's conditions.

Current selection of pa

dd to the challenges in developing combination products:

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

ers for participation in the BPI is based on fifty top-volume providers across all United States that have received Billing Precision services for more than s

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

ix months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

Billing Precision updates its index on a monthly

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

basis.

Volume Weighting

BPI is volume weighted, which is important to accomodate future growth of provided information, index combinations, and sen

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

itivity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average

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

Professional from academic institutions, pharmaceutical industries, health care indust

across all medical specialties of percent of accounts receivable beyond 120 days is 17.7%.

Summary

Medical Billing Performance Index helps the deve

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

opment of billing industry standards. Medical service providers can use the index to benchmark their billing performance and to guide its improvement over ti

.

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

me. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attributes, such as numbers of processed c

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

Companies that provide selfless information through particip

aims, accounts receivable distribution, certain mix of CPT codes, or patient demographics. Relative payer index provides billing process improvement direction

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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