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Answers - NPI For Compliant Electronic Medical Billing – A Payer's Opportunity To Streamline Operations
Motivation – Poor Provider's Data Quality
The provider's demographic data is dynamic by nature. Providers move their offices, add facilities, change their
The provider's demographic data is dynamic by nature. Providers move their offices, add facilities, change their
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
phone numbers, are sanctioned and stop practicing. Poor healthcare provider's data quality affects virtually every aspect of healthcare payer's enterprise, diluting
; 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
profits and member goodwill. Their applications, interfaces, databases, files and reports currently use legacy provider identifiers. Provider data often exists in
lude drug-coated devices, drugs packaged with delivery devices in medical kits, and drugs and devices packaged separately but intended to be used together.
ot one but many disparate databases throughout a healthcare payer’s IT enterprise, including multiple variations of the same provider record. Provider's variations
here is enormous increase in the number of combination products entering the market in the recent years. Combination products have proven advantages but fixe
and discrepancies generate as much as 12 percent of physicians checks returned, raise numbers of support calls, increase manual claim adjudication, and impede iden
d dose combinations are still in the process of convincing regulatory authority on their advantages over the single ingredient formulations.
Combination pro
Combination pro
ification of billing fraud and abuse. For instance, the cost of single check re-issue alone can reach $20 for opening/handling, researching the correct provider, r
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
issuing and mailing the check.
Opportunity – HIPAA
The 1996 Health Insurance Portability and Accountability Act (HIPAA) established national privacy and
Opportunity – HIPAA
The 1996 Health Insurance Portability and Accountability Act (HIPAA) established national privacy and
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
security standards for electronic health care transactions, including a national identifier for providers, health plans and employers. Accordingly, by May 23, 2007
nation products and maximize the revenues. But the companies involved in this practice are overlooking that they are burdening the patients both economically
health care providers and all health plans and clearinghouses must change both their processes and information systems to implement HIPAA’s National Provider Ident
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
fier (NPI) regulations.
Successful transition to NPI is critical to every aspect of operations and impacts eligibility and authorization processing, provider enrol
ts. Some of the combination products were well accepted by physicians while others suffered. Companies involved in development of combination products are fi
ment, contracts and directories, claims adjudication and payment, referrals, and reporting. It
- Simplifies communication and administration
- Streamlines detection of billing fraud and abuse
- Improves debt col
- Reduces cost to re-issue checks
- Improves accuracy of provider directories and reduces support cost
- Reduces co
- Assigned for life to a provider and de-activated only upon death, retirement, or identity theft
- Independent of key p
- Clean - Create good provider's recor
- Crosswalk - Build a crosswalk between NPI and legacy provid
- Maintain – Actively manage and clean provider data records as they change in the future.
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
> Facilitates efficient electronic transmission of health 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
ection efforts
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
t of claim adjudication – the cost of auto-adjudicated claim is $.40, 10-fold less than a manually adjudicated claim.
Means - NPI
Means - NPI
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
> A unique 10-digit identification number
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
Replaces multiple legacy provider identification numbers, including Medicare UPINs, commercial payer Ids, and state Medicaid IDs
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
ovider information changes, such as practice location or specialty
Payer Challenges
Payer Challenges
y and representatives from various regulatory agencies are working out to design the regulatory requirements for manufacture and sale of combination products
ds by reconciling, standardizing, augmenting and integrating legacy provider data.
.
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
r identifiers. Since many providers have multiple locations and affiliations, the crosswalk of NPIs to legacy provider identifiers used in different provider files
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
might be a complex one-to-many mapping.
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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