Practice Pearl

Negotiate with your top payers to obtain the highest reimbursement rates.

Reimbursement Checklist

  • Provide documentation to payers, including invoices showing how much your practice paid to acquire a specific drug.

  • Update your payer documentation frequently, especially when major legislative changes occur.

  • Include care pricing and financial aid information in your standard New Patient and Patient Support materials when setting up new patients for reimbursement.

  • Demonstrate why payers should pay you more to deliver a specific therapy via improved outcomes and higher medication adherence.

Track the following items when building your quality improvement case for higher payer reimbursement.

  • Your itemized, per-service cost at your practice
  • Your detailed, invoice-based drug reimbursement methodology (ie, consider sharing only when requested by payer)
  • Your professional rates sheet
  • A detailed list of administration codes (ICD-10, J-codes, etc) used at your practice

To help you better project drug reimbursement rates, visit this site for a list of current standard Medicare Part B drug payment rates.

Practice Pearl: Consider having infusions run during your clinical downtime, such as when you and your staff are charting. That way, you are still available for patient consult and supervision should the need arise, but you are not taking time away from essential charting tasks.