Squibb Diagnostics, a unit of Bristol-Myers Squibb, started atelephone hotline service two years ago to assist its pharmaceuticalcustomers in obtaining Medicare and private insurance reimbursement.The company used an outside consultant for the first year
Squibb Diagnostics, a unit of Bristol-Myers Squibb, started atelephone hotline service two years ago to assist its pharmaceuticalcustomers in obtaining Medicare and private insurance reimbursement.The company used an outside consultant for the first year buttook the service in-house in 1990, said Patricia Barnett, directorof reimbursement services.
"We were interested in expanding the function of the hotlinebeyond simply answering questions," Barnett told SCAN. "Wealso wanted to track trends and understand better what is happeningin the marketplace, so we could be more proactive in assistingcustomers."
Squibb links the reimbursement hotline service with its Diagnosticsfield-reimbursement staff. The contrast agent supplier has sixindividuals in the field who can visit customer sites to workout more severe reimbursement difficulties. Most questions, however,can be answered by phone or fax, she said.
"There are a number of different (reimbursement) issuesthat arise," Barnett said. "There may be suggestionswe can offer, such as using different codes or attaching lettersof medical necessity. These are ideas that might assist them inimproving reimbursement."
The reimbursement area of greatest concern to hotline customerswithin imaging is the use of nonionic radiographic contrast agents,Barnett said. Squibb sells the nonionic agent Isovue.
Initially, both private payers and Medicare reimbursed nonionicsat the ionic level, which pressed users financially because nonionicsare more expensive. Gradually, however, insurance companies havecome to realize that nonionics have additional clinical benefits.
"The use of these (nonionic) products has certainly expandedin the radiology community. Many (reimbursement) issues have begunto resolve themselves, with payers reviewing their payment mechanismsand deciding to pay at a higher rate. As use increases, reimbursementhas also increased," she said.
Although the Health Care Financing Administration has not endorsedhigher Medicare payments for nonionics (see story, page 4), theagency is apparently reviewing the question and may consider proposalsto change the payment mechanism, she said.
Cardiogen, Squibb's rubidium tracer for positron emission tomography,faces an even more daunting task in obtaining reimbursement, sinceMedicare does not reimburse for PET procedures themselves.
"It is an interesting problem," Barnett said. "Technically,they (HCFA) are supposed to reimburse for FDA-approved drugs.Unfortunately, it (Cardiogen) is tied to a procedure which isn'tapproved."