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HomeInsights Blog

USP <800> Implementation Goes into Effect December 1

In just over six months, USP <800> regulations will go into effect. USP <800> deals with the proper handling of hazardous and non-hazardous drugs, designed to prevent harm to both your staff and patients. The regulations, which have been delayed for implementation, become official on Dec. 1, 2019. That date is not expected to change.

Accounts Receivable Management Tips

As patients face higher deductibles and out-of-pocket costs, practices need to have processes and tools in place that allow patients to focus on getting the care they need, help patients meet their financial obligations and ensure that both the patient and the practice do not place themselves at financial risk.

Revenue Cycle Management Survey – What Does it Mean for your Practice?

Black Book Market Research annually evaluates leading service providers across 18 operational excellence key performance indicators completely from the perspective of the client experience. In a 2017 survey of Finance and Revenue Cycle Management they covered a variety of topics including patient payment solutions, patient accounting and patient management, complex claims solutions and patient access, to name a few.

Core Elements in Your Payer Contracts

Adequate and timely reimbursements are essential to an independent medical practice. Practices’ operational leaders should create and maintain a spreadsheet master for their top five or six major payers. Reviewing and understanding the complex components of each contract is crucial to avoiding claim denials and offering comprehensive (and reimbursable) services to patients.

CMS Looks at Over- and Underpayments

Each year, the Centers for Medicare & Medicaid Services (CMS) calculates the Medicare Fee-for-Service (FFS) improper payment rate through a program called Comprehensive Error Rate Testing (CERT). Because of this program, CMS has been able to decrease its error rate.

Advanced Analytics are Vital to an In-Office Dispensing Program’s Success

ION Solutions’ Specialty Oncology Network (SON) pharmacy and dispensing program was developed to help community oncology practices capture additional revenue from filling oral oncology prescriptions. The advanced analytics available through the SON make it easy for practices to measure performance and optimize patient care. One tool, Smart Rx Analyzer, provides a dynamic view of a practice’s dispenses so staff can quickly detect patterns and take steps to improve clinical operations and efficiencies.

Reimbursement of Biosimilars without Q Codes

The future of drugs is biosimilars, as controlling costs has long been a focus of the Centers for Medicare & Medicaid Services (CMS) and private payers. While generic drugs are identical to their branded counterpart, biosimilars are a biological product that is highly similar to its reference product, notwithstanding the minor differences in its clinically inactive components. Given the complexity of how biosimilars are grown (complex living systems vs. chemical synthetization in generics), it is unlikely for biosimilars to be exact replicas of the original.

Addressing Your Office Procedures to Combat the Perception of Fraud

The Fraud Prevention System (FPS), implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011, uses models that predict suspicious behavior with the goal of preventing the payment of fraudulent claims. This system has saved the federal government millions of dollars. 

NOC Claims and Ensuring Your Practice is Reimbursed

When there is a new drug or procedure that comes to market, it typically takes the Centers for Medicare & Medicaid Services (CMS) about six months to evaluate it and determine a reimbursement rate. During that time period (sometimes up to a year), practices can start billing under a Not Otherwise Classified (NOC), Unspecified or Miscellaneous Code.

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