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Medical billing industry has volumes of arcane terminology and payer- and time-dependent claim validity and pricing interpretation rules, facilitating massive payments of i

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

nvalid or ineligible claims and denials of error-free claims. Process transparency provides its participants greater visibility of internal process activities. An increas

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

Examples of combination products may in

ed level of access promotes teamwork, increases client satisfaction, and assists in process streamlining.

Billing process is the interaction between the participants (i.e.

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

, insurance company (payer), healthcare service provider (provider or doctor), patient, and billing service provider (biller)) designed to pay or deny a payment request (cl

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

aim) submitted by the biller to the payer and to the patient on behalf of the provider. The amount and complexity of billing information make it very difficult for the doc

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

Combination pro

or to maintain compliance and identify and resolve errors and underpayments.

Billing service transparency allows participants of the billing process to expedite error iden

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

tification and resolution, resulting in reduced over- and under-payments and improved regulatory compliance.

Attributes of Billing Transparency

Billing transpare

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

ncy has four key attributes, including universality, continuity, ubiquity, and scalability.

Universality: every participant in the billing process, inc

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

luding patient, provider, payer, and biller, has access to every aspect of the billing process.

Continuity: process detail is available continuously on

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

a 24 x 7 basis.

Ubiquity: access to billing process is provided over secure standard Internet browser that requires no special hardware or software an

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

is available everywhere.

Scalability: both the big picture and minute detail are available for scrutiny universally and continuously. The big picture

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

Following aspects would a

consists of total cash flow in a given time period, current submitted and failed claims, and billing quality metric. It must contain comprehensive summary of patient visit

dd to the challenges in developing combination products:

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

s and unpaid balances. The minute detail pertains to individual claims making up the big picture, including complete history from the moment of creating the claim, testing

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

its validity and eligibility, making corrections, performing submissions, reconciling payer messages and explanations of benefits (EOB) with original claims, until payment

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

. Both perspectives must allow arbitrary aggregation of claims and drill in for detail to enable effective followup.

How to Build Transparency Into Your

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

illing Service?

A transparent billing service leverages technology to enable competent personnel to execute disciplined billing process. Therefore, to implement a tra

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

Professional from academic institutions, pharmaceutical industries, health care indust

nsparent billing process, you must

[ ] Get access to adequate technology to support universality, continuity, ubiquity, and scalability.

[ ] Develop and thoroughly docume

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

nt claim processing procedures, including compliance and integration with practice workflow.

[ ] Train personnel in following the procedures and using the technology

[ ]

.

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

Review personally and continuously billing quality, technology capabilities, adequacy of procedures, discipline, and training.

Note that Vericle-like technologies based on

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

Companies that provide selfless information through particip

Straight Through Billing (STB) methodology implement billing transparency by design because billing transparency is an integral attribute of every component of STB process

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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