Wiki Allergy Office Admin Fees

[kstine713]

Our Allergy providers feel as if they aren't being compensated fairly for all the paperwork they are having to fill out for their patients receiving Biologics. Per our providers applications have to be completed for the pharmacy, a "Quick Start" form often has to be completed as well. They also make phone calls to offices & pharmacies, have re-submissions of those forms, other authorizations needed from insurance, etc. I wanted to ask how other offices are being reimbursed for the administrative burden specifically related to Biologics? Can the patient be charged an annual fee to cover the time & work?

 

[Christal]

We have never charged a fee for the administrative side. We have our nurses fill out the paperwork for the biologics that the patient starts and the provider reviews and signs the form. If an appeal is needed for to get the approval then the physician will do a letter and we attach it.

 

[thomas7331]

Administrative work is classified as 'overhead' and in most cases is considered a component of the services for which providers are already being reimbursed. If your office is contracted with the patient's payer, it is most likely not possible to bill the patient any additional charges for this. You may want to look at billing some of the prolonged services codes if the time spent meets those codes' descriptions and guidelines.

Another option many providers are beginning to pursue to cover these kinds of costs is to become a 'concierge' practice (it sounds like this is what your providers may be looking for), under which arrangement the patients would sign a contract and pay an annual fee to be accepted as a patient at the practice each year - it's sort of like having a 'membership fee'. It can allow your providers to take fewer patients and thereby free up time for these extra administrative tasks. But your providers would need to consult with an attorney to set up this kind of practice to ensure that the the specifics of the arrangement don't violate any of your state's laws or the terms of your existing payer contracts.