Pharmacy claims processing is highly specialized and requires significant expertise and infrastructure to accomplish it well.  For example, few companies (other than PBMs) have agreements with large community pharmacy networks for provider services or have the capacity to handle millions of electronic transactions daily.  Therefore, entities like insurance companies and TPAs often outsource the management of pharmacy benefits to one of the major PBMs.

 

Medical imaging is among the fastest-growing areas of healthcare spending.  Government Accountability Office (GAO) and America's Health Insurance Plans (AHIP) project annual growth exceeding 20% in the next five years.

 

Health plans with unmanaged radiology benefits see double digit growth while payers that use pre-certification have seen minimal or no increase annually.

 

These attempts to control access to medical imaging procedures highlight the failure of policymakers and payers to adequately and rationally address the growth in imaging utilization.  Payers believe the use of RBMs engages providers in "shared responsibility for judicious use of imaging services".

 

Purchase this webseminar and learn how to successfully navigate the Medicare Pre-certification mandate while also learning how benefit management companies are becoming the new gatekeepers of healthcare and are controlling the process from start to finish.

 

Objectives:

Who Should Purchase:

 

This program is designed for executives from health plans and pharmacy programs with responsibilities in the following areas:

This webseminar will also benefit third parties with expertise in Medicare, auditing, fraud and abuse, claims processing and coding, and pharmacy benefits management.

 

About the Presenter:

Barbara Ossias, Principal, Reimbursement Revenue Solutions

 

Barbara Ossias has more than two decades of experience working on the reimbursement issues related to medical imaging and nuclear medicine.  She has represented manufacturers in coalitions, including the Medical Imaging Contrast Agents Association and Coalition of Radiopharmaceuticals and Radionuclides, and has been an invited speaker at state, national, and international meetings since 1989.  Her firm, Reimbursement Revenue Solutions, is located in the Washington, DC, metropolitan area.