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