Category Archives: Product Updates

Below is the transcript and demo from our on-demand MicroWebinar:  Road Testing the RJ Health Medical Drug Edits and API Platform RJ Health’s MDEs intake customer claim data and apply our best in class medically covered drug data and algorithms in order to improve reimbursement timeliness, drug coding, and payment accuracy, drug formulary adherence, and […]

In Medical Drug Edit Blog Posts #1 & #2, we learned how Medical Drug Edits can enhance Medical Drug claim submission and reimbursement accuracy.  However, the utilization of an API (Application Programming Interface) to deliver Medical Drug Edits can further improve the Medical Drug pre-claim review process. Specifically, the use of an API can: Speed […]

INSIDE THIS ISSUE CMS News New HCPCS® C-Codes Effective April 1, 2019 Now Available Quarterly ASP (Average Sales Price) Pricing File Revised for April 2019 April 2019 NOC (Not Otherwise Classified) Pricing File Hospital OPPS (Outpatient Prospective Payment System) Update Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Prioritize your […]

Increasing healthcare costs continue to outpace inflation in the United States. Specialty drug costs are the largest driver and component to healthcare spend. This surge has led to transformative patent care but has also given rise to a disproportionate total healthcare spend. Major drivers of medical drug spend are the complex processing of medical drug […]

INSIDE THIS ISSUE CMS News Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information Software Updates Prioritize your Code Level Pricing CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for the change. Of the 35 […]

In Medical Drug Edit Blog Post #1, we saw that pre-payment edits of Medical Drug claims can be utilized to improve claim submission and reimbursement accuracy.  Payors and providers license RJ Health’s Medical Drug Edits and access them via our API platform. This is because effective pre-payment review of medical drug claims requires: •  The […]

Drugs covered under medical benefit plans and their costs are difficult to manage. These challenges are due to: •  Limited clinical visibility and control •  Unaccommodating medical claims and claim systems •  Complex billing and reimbursement requirements related to coding and pricing As a result, medically covered drug claim errors are almost the norm.  In […]

In an effort to contain growing healthcare costs, Congress enacted the Omnibus Budget Reconciliation Act of 1990 (OBRA’90) and created the Medicaid Drug Rebate Program. Pharmaceutical manufacturers’ participation in the program became a prerequisite for Medicaid coverage of outpatient prescription drugs.Since then, states have been required to collect associated drug rebates to receive federal funding […]

Starting on January 23rd, when you visit ReimbursementCodes.com, you will see a brand new website. When you login to your account at the top of the page you will still be directed to the classic ReimbursementCodes website. This new public site will give you a taste of the new ReimbursementCodes experience coming in the next […]

Having personally dismissed 99% of these CEO missives, I wrestled with the need, never-mind the value of this communication. My objective since taking the reins of RJ Health Systems in 2015 has largely been to distinguish us from the jargon-filled, oftentimes frenzied industry heavyweights we operate alongside in service to Payors and Providers in the […]