Payer policy
Buy and bill
The practice purchases a drug, administers it and bills the payer, carrying the inventory cost and reimbursement risk.
What it means in dermatology
Common with dermatology biologics. The margin depends on acquisition cost against the payer's allowable, and on authorization being secured before the dose is given.
The alternative, specialty pharmacy, removes the inventory risk but also removes the margin and adds scheduling friction.
Why it matters to your revenue
A single denied biologic administration can erase the margin on many others.
See this term in your own numbers
A free claims audit reviews a de-identified sample of your dermatology claims and returns a line-item findings report — including where terms like this one are costing you money.
Request a free claims audit