Get help with your day to day practice operations here, with resources for biologics processing, staffing, regulatory issues and scheduling/workflow.
Biologic Therapy Pearls
Correct documentation will help you get the approval done right the first time. Understand the mechanisms and what is needed for approval for each medication; variations exist throughout the country. For example:
• Is spirometry with an FEV1 < 80 required?
• What is the eosinophil count needed for a particular anti-IL5 agent?
• What is the IgE level for Xolair?
Have a solid medication history documented, including:
• Leukotriene modifier
• Prednisone use (How much?)
• Rescue inhaler use
• ER visits/hospitalizations/ICU admissions
With insurance or specialty pharmacy company contacts, have a direct phone number and a name of a person.
Minimize office burden by:
• Asking the patient to help call for the order to be shipped and also take responsibility. Our patients call one hour prior to biologics administration to ensure dosage isn’t wasted or prep done unnecessarily.
• Encouraging the patient to explore appropriate assistance programs.
• Appointing one central coordinator/designating other staff involved in the process.
• Clearly documenting workflow requirements.
Document the clinical benefit and use the correct codes. If you have a visit, code the reason for the visit separately from the injection code.
Make sure standard anaphylaxis precautions are in place, and prescribe epinephrine auto-injectors for your patients on certain biologic therapy.
Buy and Bill
• Buy and bill is not just for Medicare. Commercial insurance offers it as well.
• Purchase agreements vary. Take advantage of invoice discounts, price protection, and volume-based discounts
• Wholesaler Acquisition Cost (WAC) - national acquisition cost by the manufacturer
• Average Selling Price (ASP) - quarterly calculation by Medicare using cost data by manufacturers
• In general, Medicare reimbursement is ASP + 6%, but commercial insurance reimbursement varies.
• Read more tips and tricks for Biologic Buy and Bill Pearls
Professional Support and Resource Sites for Healthcare Providers
• For allergic asthma and chronic idiopathic urticaria - Xolair (omalizumab)
• For eosinophilic asthma, atopic dermatitis, and chronic rhinosinusitis with nasal polyposis - Dupixent (dupilumab)
• For eosinophilic asthma -
o Nucala (mepolizumab)
o Fasenra (benralizumab)
o Cinqair (reslizumab)
The main goals of the Health Insurance Portability and Accountability Act (HIPAA) are to:
• Protect health insurance coverage for workers and their families when they change or lose their jobs (portability)
• Protect health data integrity, confidentiality, and availability (accountability)
The core elements of an effective HIPAA compliance program for an allergy/immunology office are:
• Written policies and procedures
• A designated compliance officer/compliance committee
• Effective training and education
• Effective lines of communication
• Internal monitoring and auditing processes
• Enforcement of standards through well-publicized disciplinary guidelines
• Health IT Privacy and Security Resources for Providers
• HIPAA Wake Up Call
• Centers for Medicare and Medicaid Services (general HIPAA information)
• HHS Guidance on HIPAA for Medical Professionals
The Occupational Safety and Health Administration (OSHA) is committed to protecting workers from toxic chemicals and deadly safety hazards at work, ensuring that vulnerable workers in high-risk jobs have access to critical information and education about job hazards, and providing employers with vigorous compliance assistance to promote best practices that can save lives.
Is your practice OSHA compliant? The following resources will help you get started.
• General OSHA information
• Medical Screening and Surveillance Requirements in OSHA Standards
• The OSHA Job Safety and Health: It's the Law Poster, available for free from OSHA, informs workers of their rights under the Occupational Safety and Health Act. All covered employers are required to display the poster in a conspicuous place in their workplace
• Some states have specific OSHA-approved plans
• Sign up for OSHA’s e-newsletter QuickTakes, which provides the latest news about enforcement actions, rulemaking, outreach activities, compliance assistance, and training and educational resources.
• To report an emergency, fatality or catastrophe, order publications, file a confidential complaint, or for questions or advice, contact OSHA
• Finding, Training and Keeping the Right Staff for Your Practice (2015 PMW presentation)
• Practice Management Resource Guide Chapter 5: Staffing and Human Resources Issues
• HR Legal Primer: Strategies for Allergy Practice
• Hiring the Best Administrator for Your Practice (2016 PMW presentation)
• Utilizing Nurse Practitioners and Physician Assistants in Allergy Practice
Office Efficiency and Protocols
• Penicillin Handout (2019 PMW presentation)
• Analyzing and Improving Work Flow in Your Practice (2016 PMW presentation)
• Web Tools for Clinical Practice
Items which appear next to a symbol are for AAAAI members only.
These links are for research only. They are not endorsed by The American Academy of Allergy, Asthma & Immunology (AAAAI).