Understanding the buy-and-bill model
How the process works, is typically through a “buy-and-bill” model of reimbursement. Your providers will “buy” the drug or treatment that is administered to the patient in your office or infusion center. In some cases, the drug can be warehoused at a distribution center, so you have it available when you need it for your patients, but in most cases, the drugs will be shipped directly to your office. The Group Purchasing Organizations (GPOs) can also help to negotiate the cost of the drug when they represent many practices’ orders to a manufacturer, as well as negotiating the extended terms on cost. Those terms can vary by product, but often the shorter the term for payment, the better your pricing for the product. The GPO will help negotiate your contracts with many different manufacturers, depending on your patients’ needs and your prescribing patterns.
Your practice will work with the payers to get prior authorizations for treatments when your patient is diagnosed. Your office will work with the patient to collect deductibles and co-pay insurance, while you also submit the claim for reimbursement from the payer – the “bill” part of the model.
Having extended terms for the purchase and invoicing for the medications will help your office travel through the PA and reimbursement process. If your practice is part of a specialty GPO, the GPO will also secure rebates and discounts based on the volume of the entire purchasing group of practices.
While the practice takes on the financial risk, partnering with the GPO or distributor to understand purchasing patterns will help your practice manage inventory on most recent data.
What the buy-and-bill model does allow for is the clinical decision-making being left to the providers.
Watch a short video on the model.
Many new infusible therapies are coming to market, creating an opportunity for your practice to offer infusion services to your patients. Our team of experts can guide your practice through starting a new or expanding an existing infusion suite. Start a conversation with our Business Consulting team by emailing John and Kristy at firstname.lastname@example.org.