Buy & Bill: Maximizing Copay Assistance Programs with a Reactive Approach

*OBJECTIVES:* 1. Explain the complexities of outpatient infusion reimbursement models, specifically in relation to the drug buy and bill process. 2. Discuss the obstacles associated with typical approaches used to handle copay assistance programs within the buy and bill model. 3. Provide a comprehensive overview of successful strategies and resources for effectively managing the utilization of copay assistance programs for infusion drugs. 4. Identify crucial internal stakeholder departments necessary for implementing enhancements to optimize the efficiency of copay assistance program utilization. *DETAILS:* The presentation will outline challenges commonly faced when managing copay assistance programs for buy and bill drugs, highlighting potential pitfalls and areas for improvement. These challenges include: Difficulties in tracking patients proactively enrolled in copay assistance programs Prolonged waits for insurance payments leading to delayed access to Explanation of Benefit (EOB) documents Reliance on alternative documents in lieu of misplaced EOBs Submission of documents to copay programs Tracking remittance from copay programs Ensuring accurate payment posting by the infusion revenue cycle team Specific strategies will be presented to address these challenges. For instance, at Memorial Healthcare System, a report generated by the business intelligence team targets patients who have received infusions and already possess existing EOBs. This approach eliminates the need to track pre-enrolled patients and wait for EOB availability. Additionally, the presentation will emphasize ongoing communication and collaboration with the revenue cycle department to manage each account effectively and ensure proper payment posting. *SUMMARY:* This presentation will offer valuable insights and practical recommendations for healthcare professionals engaged in managing outpatient infusion reimbursement and copay assistance programs within the buy and bill model.