NAPERVILLE, Ill., June 11 /PRNewswire/ -- Health plans now have the ability to manage the rising costs associated with the reimbursement of Rx Injectable medications using RxI(TM), a unique service offered by Concentra Preferred Systems to address the industry need of pharmacy cost containment.
Numerous factors can lead to potential over billing and subsequent overpayment for injectable medications including: the number of units billed to a payor or patient, the chemical stability, product selection, package size and multiple-dose vial considerations. In addition, unit integrity errors can result in increased costs of more than 50 percent for injectable medications administered by physicians or other outpatient settings.
The rate of development and FDA approval for these high-cost medications has accelerated in recent years, with no slowdown anticipated. According to the Center for Studying Health System Change, prescription drug spending grew 13 percent in 2002 and accounted for over one-fifth of overall healthcare spending. A major factor to these increased costs is injectable medications -- with an estimated increase of 20-25 percent since 2000.
Concentra Preferred Systems RxI cost management service addresses the growing industry need of pharmacy cost containment. Concentra Preferred Systems' experienced clinical pharmacy staff and auditors take a comprehensive approach in determining what supports the codes and units billed on these high cost claims by identifying and validating actual physician orders and units of medication prescribed. In addition, the audit and re-pricing process of RxI helps payors incorporate new contract language to contain costs for these specialty products and services going forward.
According to Dave Cardelle, RPh and Vice President of Post-Payment & Ancillary Services for Concentra Preferred Systems, "There are over 300 new high cost biologicals (injectables) awaiting further testing and eventual FDA approval. Once approved, these medications are projected to enter the market at very high costs relative to most current pharmacy pricing levels. At this rate of development, in addition to existing reimbursement and accurate billing challenges, payors should be concerned and aware of the financial impact this may have on their medical costs into the future."
About Concentra Preferred Systems, Inc.
Concentra Preferred Systems, Inc., a wholly owned subsidiary of Addison, Texas based Concentra Inc., is the industry leader in outsourced, specialized claims cost management services for health plans. The Concentra Preferred Systems service portfolio includes: professional claims resolution, repricing, auditing, proprietary facility UCR applications and consultative services that help lower costs, increase productivity and maximize return on investment in the area of claims transaction management. All rights reserved. http://www.cpsconnect.com/
About Concentra Inc.
Concentra Inc. is the comprehensive outsourcing solution for containing healthcare and disability costs. Serving the occupational, auto and group healthcare markets, Concentra provides employers, insurers and payors with a variety of integrated healthcare services. These services include employment- related injury and occupational healthcare, in-network and out-of-network medical claims review and re-pricing, access to specialized preferred provider organizations, first notice of loss services, case management and other cost containment services. Concentra is a registered trademark of Concentra Operating Corporation. All rights reserved. http://www.concentra.com/
To receive Concentra Preferred System (CPS) news releases by e-mail, contact axpeterson@concentra.com . Please include your name, affiliation and e-mail address. CPS news releases are available at http://www.cpsconnect.com/ .
Available Topic Expert(s): For information on the listed expert(s), click appropriate link. Dave Cardelle, RPh http://www.profnet.com/ud_public.jsp?userid=347215
Concentra Preferred Systems, Inc.CONTACT: Amanda Peterson, +1-630-649-5237, or Axpeterson@concentra.com ,or Gene Della Torre, +1-630-649-5045, or Gdellatorre@concentra.com , both ofConcentra Preferred Systems, Inc.
