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This article is about how to effectively bill for Physical Medicine & Rehabilitation with Intervention Pain management services in an outpatient setting. This article

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

is very useful for Board Certified Physician in Physical Medicine & Rehabilitation, Board Certified Physician in Pain Medicine and Intervention Pain Management practic

; 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. If you are the medical biller:

1) First thing, make sure your provider is listed under his correct specialty with the insurances. Remember that Pain Management pro

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

vider do not necessarily mean they are (PM&R) M.Ds. They can be Anesthesiologists, Chiropractors, Acupuncturists, Massage Therapists, Physical Therapists and Occupatio

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

nal Therapists! Many claims were denied for payments like for CPT code 64480, 64483, 64484, 27096 and all other related procedure codes (you will see on the EOB a “rea

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

Combination pro

on code” like this: the provider is not privileged to do the procedure)--- it is because your provider might have been only listed as a Pain Management provider and NO

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

T as PM&R and Pain Medicine medical provider.

(2) In terms of Patients’ Benefits, remember that each patient has different Pain Management benefits non-inclusive with

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

PM&R office visits! Some plans do not have pain management benefits!

(3) Make sure you have all the fee schedules assigned to your provider both for outpatient hospi

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

tal and office procedures. Compare which one allows descent amount based on your billed amount

(4) Claims must be accompanied with medical documentation to support me

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

dical necessity (this is very important!). If the insurance requests for documentation, send it right away! So they do not delay processing your claims. If there is a

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

eferral or letter of precertification, attach them too!

(5) Procedures like CPT codes 72040, 72020, 72100, 72295, 73542, 76005 done in the hospital, you must use modi

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

Following aspects would a

fier 26 (professional component only, the medical equipments are from the facility or the hospital). Normally, this is with location code 22 (Outpatient Hospital). If

dd to the challenges in developing combination products:

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

the procedure is done in the office, do not use modifier 26. Instead use location code 11 without a modifier.

(6) Procedures done bilateral use modifier 50.

(7) If t

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

he provider performed an office procedure like CPT Code 64405, 20552, 20553 and sees the patient for office consultation on the same day, use modifier 25 for consultat

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

ion CPT code.

(8) In terms with the insurance companies, which pays more? to which CPT procedure code? I think procedures done for Workers’ Compensation and “No-Fault

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

patients allows higher based on the billed amount compared to all other insurance companies.

(9) Take note: Workers Comp and No Fault patients ALWAYS needs precertif

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

Professional from academic institutions, pharmaceutical industries, health care indust

ication/preauthorization for procedures to be done either in an outpatient hospital or office.

(10) Generally, it is always a safer side to check on your patients’ be

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

nefits and eligibility before you render the service or do the procedure.

(11) And if you are a provider’s office, make sure you choose the best medical billing servi

.

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

ce that will submit your claims on a timely manner. Highly knowledgeable with HIPAA and with your specialty in terms of processing your claims both electronic and pape

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

Companies that provide selfless information through particip

r submission. Of course, you also have the option to purchase the best medical billing/accounting software that is cost-effective and won’t hurt your overhead expenses

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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