Supporting Your INOMAX Reimbursement Needs
A 24/7/365 commitment to service
We know the reimbursement process is an important component of supporting INOMAX usage at your institution. As part of our commitment to 24/7/365 service and support, we are available to provide information to help with your on-label INOMAX reimbursement challenges as part of the services included in your contract as an INOMAX customer.
INOMAX reimbursement assessment and assistance
As an INOMAX customer, your National Account Manager (NAM) can offer ongoing support to help you navigate the reimbursement process. Your NAM can assist you through the following:
Managed care updates
In the constantly changing and challenging managed care landscape, your NAM can provide Mallinckrodt’s understanding and perspective on local, regional, and national reimbursement trends.
In the constantly changing and challenging managed care landscape, your NAM can provide Mallinckrodt’s understanding and perspective on local, regional, and national reimbursement trends.
Situational and strategic assessments
Together with your finance and clinical teams, your NAM can assist with identifying current reimbursement strategies for INOMAX. You are ultimately responsible for determining the appropriate reimbursement strategies and billing codes.
Together with your finance and clinical teams, your NAM can assist with identifying current reimbursement strategies for INOMAX. You are ultimately responsible for determining the appropriate reimbursement strategies and billing codes.
Ongoing support
Your NAM can work with you to facilitate periodic reviews to support your reimbursement strategies and processes.
Your NAM can work with you to facilitate periodic reviews to support your reimbursement strategies and processes.
You are ultimately responsible for determining the appropriate reimbursement strategies and billing codes.
Here for You When Reimbursement Challenges Arise
Your INOMAX team is committed to supporting you throughout the reimbursement process.
If you are experiencing a reimbursement challenge:
- CONTACT YOUR CRITICAL CARE BUSINESS MANAGER (CCBM) to discuss your challenge in more detail.
- ENGAGE KEY STAKEHOLDERS early in the process to identify the specific area of reimbursement concern.
- REVIEW 5 AREAS OF REIMBURSEMENT with your team to help determine the potential origin of your challenge. View more
- PREPARE FOR A PRODUCTIVE REIMBURSEMENT MEETING with your CCBM, NAM, and all key stakeholders. View more
5 areas of reimbursement focus
After talking with your CCBM, work with your internal team of stakeholders to review these areas to help determine the potential origin of your INOMAX reimbursement-related challenges.
- Ensure prescribing HCPs are coding INOMAX as a drug, not a medical gas
- Confirm that the neonates’ diagnoses are appropriately documented to avoid any potential off-label concerns
- Verify that the order for INOMAX is correctly documented in patient charts and that the medical records department recognizes the order and uses the ICD-10 procedure code: 3EØF7SD
You are ultimately responsible for determining the appropriate reimbursement strategies and billing codes.
- Meet with purchasing/contracting/sourcing personnel to review contracts of primary payors to assess any specific clauses pertaining to high-cost pharmaceuticals and cost outliers
If these clauses exist…
- Identify the payor’s coding requirements to help support reimbursement.
- Identify who maintains the charge description master (CDM) at your institution, and determine how the charge is set up in the CDM
- Confirm all appropriate codes are entered into the chargemaster and that all charges associated with INOMAX are appropriately coded and captured
You are ultimately responsible for determining the appropriate reimbursement strategies and billing codes.
- Understand how INOMAX is addressed in your payor contracts—this is important. There may be special provisions to determine if your institution’s utilization is material and may warrant additional payments
- Consult with contracting/purchasing/sourcing personnel to help identify areas of opportunity and risk, and proactively address them through contract negotiations
- Work with purchasing/contracting/sourcing personnel to perform a retrospective analysis on the reimbursement history for INOMAX to determine whether contracted payment is being received
Preparing for a productive reimbursement meeting
The following checklist can help you prepare for a productive meeting with the CCBM, NAM, and all key stakeholders:
ENGAGE key stakeholders based on the reimbursement challenge
Documentation and coding?
- INVOLVE prescribing physicians, respiratory therapy director, and coding and billing
Reviewing contracts/managed care strategy/monitoring reimbursement?
- INVOLVE contracting, purchasing, and sourcing
Reviewing the chargemaster?
- INVOLVE revenue cycle review manager, coding and billing, respiratory therapy director, and pharmacy
DETERMINE a date and time when all key stakeholders are available to attend
Each key stakeholder has an important role in the INOMAX reimbursement process. It is imperative they are in attendance and prepared for the meeting with the NAM.
Each key stakeholder has an important role in the INOMAX reimbursement process. It is imperative they are in attendance and prepared for the meeting with the NAM.
FOLLOW UP with key stakeholders prior to the meeting to confirm attendance
Optimal attendance is key to facilitating solutions identified during the meeting and developing an action plan.
Optimal attendance is key to facilitating solutions identified during the meeting and developing an action plan.
CONTACT YOUR CCBM OR CALL 877-566-9466 IF YOU HAVE ANY QUESTIONS.