The specialty pharmacies deal with specialty drugs and creating an accurate bill for these drugs is very difficult. That’s why different types of processes such as buy-and-bill comes. The clinics choose the buy-and-bill process when they decide to get specialty drugs. The “buy” part refers to clinics ordering the medications while the “bill” part is creating an accurate bill to get reimbursement from third-party payers. Therefore, if your pharmacy handle specialty drugs, the “buy-and-bill" method can be a feasible option to bill for that drug.

But creating an accurate billing process is not that easy as it includes complex codes and modifiers. For this reason, you need to hire specialized specialty pharmacy billing services so that your staff can focus on patient care. Moreover specialty pharmacy further has strict handling and distribution protocols which include cold-chain logistics, limited distribution networks, REMS (Risk Evaluation and Mitigation Strategy) compliance and manufacturer-specific handling rules. Therefore, before diving into how they can help, let’s understand the model in detail first.

What is Buy-and-Bill-Model in Terms of Specialty Pharmacy?

The buy-and-bill process is used to manage the outpatient drugs. These drugs include injectables, IVIG, biologicals, immunoglobulins and many more. The pharmacies provide these drugs to the hospitals, and the physicians purchase these drugs via specialty distributors. However, this process is very straightforward where the provider buys these drugs from the specialty distributors and stores it for the patients.

After the patient receives the drug, the provider submits a reimbursement claim. However, its billing comes with challenges such as dealing with complex modifiers, documentation procedure and payer-specific rules. So, in case of the buy-and-bill model, the cold-chain logistics, and limited distribution networks in term of specialty pharmacy comes into the picture. Apart from that, they also follow REMS (Risk Evaluation and Mitigation Strategy) compliance in term of specialty pharmacy.

How Specialty Pharmacy Billing Impact the Financial Health of Your Practice

Many drug documentation can be a living maze, moreover specialty pharmacy need experienced billiers and HCPCS Level II J-codes (injectables and infused drugs), NDC (National Drug Code) mapping, CPT codes for drug administration (infusion, injection) and finally, ICD-10-CM diagnosis coding for medical necessity which are rare.

First of all, clinics can use this method to have higher control over their supply chain. Thus, when you can totally control your supply chain, you can choose the selling price of your medicine. Finally, you can give your own labels to the drugs so that patients can trust these drugs and don’t give a second thought of using other drugs. You may get exposed to a huge financial risk, and it can increase your administrative burden when managing a large volume of drug inventories. Many clinics don’t have the time, money, and staff to support this. That’s why clinics choose the option of external billing operation.

Wondering why there’s so much fuss about bagging? Let the exploration begin.

How Do Specialty Pharmacy Billing Services Implement Buy-and-Bill Model?

Choosing this model can be highly beneficial to increase your clinic’s revenue. The outsourced experts perform several steps to implement this model such as:

• They employ staff who can track inventory, lead time, and volume for specialty pharmaceuticals.
• These outsourced experts focus on getting approvals for the specialty treatments from the insurers.
• The RCM experts have licensed staff who administers specialty drugs to stay updated with the patient’s needs.

Additional Benefits of Outsourced Services

The in-house staff consumes a lot of resources as you need to train them and buy separate office space for them. On the other hand, the outsourced experts can reduce your operational costs by 80% and not only that, they can also provide you with 10% buffer resource.

What if you don’t like their service and want to quit? Rest assured, they don’t have any binding contract or restrictive clause.

What about tracking your results? Don’t worry, they provide customized reports so that you can track all your numbers seamlessly.

Wondering what if you want multiple services? These specialty pharmacy billing services can help with DME, urgent care, gastroenterology, infusion, cardiology and 40+ more specialties. Still confused whether to take their help or not? Request a demo and find out.