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August Billing Performance Index (BPI) underperformed July value by 8.7%, replacing six participants in the list of top ten performers and dropping the index from 15 down to 16.3. 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

reports a third iteration of a prototype for a rule-based chiropractic billing index, including its coverage definition, update cycle, volume weighting, and provided information.

BPI = 16.3 means

; or drug, device, and biological product and fixed dose combination would include two or more combinations of drug.

Examples of combination products may in

that the average of ten top performing payers working with BillingPrecision.com clients have 16.3% of Accounts Receivable beyond 120 days. BPI is a key billing performance characteristic, as it is

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

a proxy of the claims that are never paid. Obviously, the lower is the index the better is billing performance. The table below also lists the top ten performing payers and their relative index

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

as recorded in Billing Precision's system.

Billing Precision Index 16.3
Blue Cross Blue Shield Texas 2.2
Horizon 5
C

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

Combination pro

areFirst NCA 6.8

Liberty Mutual 11.6

United Health Care 11.6 (down from 5 in July)

Oxford 15.4 (down from 5.7 in July)

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

i> Medicare New Jersey 16.6 (down from 11.7 in July)

Cigna 18.3 (down from 12.4 in July)

Florida 1st 23.7

Medicare Wisconsin 42

Droppe

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

participants from July BPI:

Medicare West Virginia 1.1
Medicare Virginia 10.5
Medicare Alabama 11.9
Aetna 13

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

Blue Cross Blue Shield New Jersey 15.7

Blue Cross Blue Shield Alabama 23.9

Improved participants with respect to July BPI: None.

Underperforming participants w

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

ith respect to July BPI:

United Health Care 11.6 (down from 5 in July)
Oxford 15.4 (down from 5.7 in July)
Medicare New Jersey 16.6 (down from 11.7 in J

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

uly)

Cigna 18.3 (down from 12.4 in July)

New participants with respect to July BPI:

Blue Cross Blue Shield Texas 2.2
Horizon 5
ding difficulty in defining their combination products and facing various challenges from selecting a combination to marketing it.

Following aspects would a
>
CareFirst NCA 6.8
Liberty Mutual 11.6
Florida 1st 23.7
Medicare Wisconsin 42

Coverage

BPI is rul

dd to the challenges in developing combination products:

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

e-based, i.e., payer participation in the index is defined by dynamically rules at the time of computation and not by a static listing of specific payers. Therefore, any specific payer may start o

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

r discontinue participation in the index, dependent on satisfaction of rule's conditions.

Current selection of payers for participation in the BPI is based on fifty top-volume providers across all

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

United States that have received Billing Precision services for more than six months and have more than two hundred claims in their current Accounts Receivable.

Update Cycle

BillingPreci

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

sion.com updates BPI on a monthly basis.

Volume Weighting

BPI is volume weighted, which is important to accomodate future growth of provided information, index combinations, and sensitiv

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

Professional from academic institutions, pharmaceutical industries, health care indust

ity across multiple indices.

Information Provided

BPI computes the percent of Accounts Receivable beyond 120 days. Note that national average across all medical specialties of percent o

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

f accounts receivable beyond 120 days is 17.7%.

Summary

Medical Billing Performance Index helps the development of billing industry standards. Medical service providers can use the inde

.

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

x to benchmark their billing performance and to guide its improvement over time. Rule-based index definition allows for automated inclusion and exclusion of payers in the index based on payer attr

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

Companies that provide selfless information through particip

ibutes, such as numbers of processed claims, accounts receivable distribution, certain mix of CPT codes, or patient demographics. Relative payer index provides billing process improvement direction

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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