Five steps to easier, accurate reimbursement |
INOMAX® is a vasodilator, which, in conjunction with ventilatory support and other appropriate agents, is indicated for the treatment of term and near-term (>34 weeks gestation) neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension, where it improves oxygenation and reduces the need for extracorporeal membrane oxygenation.
INOMAX Important Safety Information (ISI)
INOMAX should not be used in the treatment of neonates known to be dependent on right-to-left shunting of blood
5-Steps to Reimbursement
1. Document and Code
Verify that prescribing physicians have adequately documented the order for INOMAX in the patient chart and that the medical records department recognizes the order and uses the ICD-9 00.12 procedure code.
2. Review Contracts
Review contracts of top payers for specific clauses pertaining to high-cost pharmaceuticals. If these clauses exist, identify the payer’s coding requirements.
3. Review Chargemaster
Appropriately code and capture all charges associated with INOMAX. Ensure that all the appropriate codes are identified and entered into the Chargemaster.
4. Develop Managed Care Contract Strategy
Negotiate special provisions in the managed care contracts of high-cost pharmaceuticals and orphan drugs. Three types of contract-provisional clauses that apply to INOMAX are carve-outs, cost outliers, and stop-loss thresholds.
5. Monitor Reimbursement
To ensure contracted reimbursement, compare actual payments to specified agreement terms.
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