Depending on the size and type of your practice, you may need to hire additional staff to support in-office infusions. These staff members may work on a full-time, part-time, or contractual basis according to the number and type of infusions you plan to do, as well as the regulations in your state and/or municipality.
IMPORTANT COMPLIANCE CHECK:
Some states may require infusion preparation and delivery to occur under the supervision of pharmacists and/or pharmacy technicians, and/or for infusion clinics to be licensed as pharmacies. Depending on the regulations in your state or municipality, it may be necessary to hire a pharmacist(s) and/or pharmacy technician(s) to oversee your infusion clinic, either on a staff basis or as independent contractors. Check with your State Board of Pharmacy or the National Association of State Boards of Pharmacy for more information on pharmacy regulatory compliance in your area before setting up your infusion clinic.
Who should you hire? It depends on a number of factors, such as clinic size, anticipated number and type of infusions, and your state, among others.
- Infusion nurses/RNs
If you are not sure where to find them, your current nursing staff or medical colleagues may be able to help you recruit staff from nearby hospital infusion centers, especially if you are offering part-time/per-diem work.
- Advanced practice nurses (APRNs; for example, Licensed Nurse Practitioners or MSNs with specialty infusion training)
These nurses specialize in infusion care and have received special training and certifications surrounding the latest best practices.
- Physician assistants (PAs)
Like APRNs, some PAs specialize in infusion care and are well versed in the latest best practices for immunologic infusions. Some PA degree programs send their students out for clinical rotations in infusions, so this could be another source of future staff if you add your clinic to a PA program’s clinical rotation site list.
- Pharmacists (often mandatory; see Compliance Check, above)
Some states and municipalities may require pharmacists to oversee the preparation and delivery of infusion medications. Whether you would need a pharmacist onsite at your office or can contract with an independent infusion pharmacy will likely depend on the rules and licensing requirements in your state.
If your in-house infusion practice is limited, consider hiring pharmacists and/or infusion nurses on a contractual or per-diem basis. This strategy can work especially well if you dedicate only specific days of the week (eg, Mondays and Fridays) as “infusion days.”
Which nurses can I hire? Where can I find them?
If you have run a private practice for any length of time, you already know that qualified RNs/BSNs willing to work in small private practices are often in short supply. However, there may be some staffing flexibility depending on your state or jurisdiction. For instance, some states may allow LPNs/LVNs who hold IV certifications to manage infusions as long as they are under the direct supervision of an RN or physician. Contact your State Board of Nursing, in writing, for specific information and regulatory requirements for infusion nursing staff in your state(s).
- Consider outsourcing. Some smaller practices prefer to outsource their billing and coding to companies that specialize in complex medical billing services. If this is an option for you, or if you do it already, find out if third-party billing companies offer onsite billing staff services on a full- or part-time basis to answer patient questions that may arise in your office.
- Integrate your clinical and billing services. Whether you keep your billing in-house or use a third-party billing company, it makes sense for you, your clinical infusion staff, and your billing staff/services to stay in close contact so you can share best practices and ensure that your practice receives maximum reimbursement for infusion services. Infusion medications and treatment protocols can change rapidly, and billing and coding services must adapt frequently to keep up with new protocols and maintain reimbursements.
- Track claims and services rendered. Any solid billing-and-coding system has a mechanism for tracking each and every infusion service conducted in your clinic and its current reimbursement status. Whether you do your billing in-house or outsource it, make sure your billing system offers this functionality. If not, consider upgrading your billing software or your billing vendor.
Claims Management Tips
Kristin Epland, MSN, FNP-C
Midwest Immunology Clinic and Infusion Center
Josh Jacobs, MD
Allergy & Asthma Medical Group of the Bay Area
Greg Bensch, MD
Allergy Immunology and Asthma Group
Paid on an As-needed Basis or Retained
- Hire a healthcare laywer or CPA.
If all of the required regulatory compliance, incorporation paperwork, and billing/coding needs for a private infusion practice seem overwhelming, it might be time to hire an expert. An attorney who specializes in healthcare regulatory compliance and business practices can handle much of the paperwork for you (especially in high-regulation states), allowing you, the clinician, to focus on patients. Similarly, a CPA familiar with the billing, coding, and tax reporting needs of healthcare companies can help streamline the set-up of a financial system that will deliver maximum infusion reimbursement and efficient payment processing. Although hiring these professional services may cost more in the startup phase of your infusion clinic, they will likely pay for themselves many times over in the long run.
Clinical Staff Training
Invest in continuing staff education.
Immunology and infusion treatment protocols can change rapidly as new therapies, indications, and clinical data emerge. Keeping your clinical staff and yourself current on the latest best practices, therapies, and adverse events is crucial to running a competitive, effective infusion practice that improves patient outcomes. Although pharmaceutical company staff can provide specific drug information, local or national immunology conferences or meetings, and online, certified CME/CE activities provide evidence-based, peer-reviewed educational opportunities for optimizing your practice’s clinical protocols and patient management. Many online CME/CE activities are free of charge, whereas some online activities and live conferences are fee/tuition-based. Staying up-to-date on the latest best clinical practices will pay off at the point of care when both you and your clinical staff can provide current, effective patient communication on medications and treatments.
Continuing education is not just for clinical staff. Billing and coding workshops can help your administrative staff stay abreast of changes in protocols related to infusion therapies and services. Many of these workshops focus on how to accurately assign CPT codes, modifiers, and diagnostic codes, as well as how to submit “clean” claims. Continuing education organizations also offer refresher classes on government and payer rules, including essential updates to the complex and ever-increasing MACRA and MIPS quality-based reimbursement initiatives.
Kristin Epland, MSN, FNP-C
Midwest Immunology Clinic and Infusion Center
Listen to a patient describe the advantages that administrative staff in a private infusion practice offer versus the staffing models commonly encountered in hospital-based infusion centers.
Amgen Assist. Reimbursement for physician-purchased and physician-administered drugs: Understanding the buy and bill process. Publication no 60889-R5-V1.