Buy-and-bill economics
The practice buys the drug, gives it, and waits to be paid. Medicare's payment limit for most Part B drugs is set quarterly from average sales price, so acquisition cost and reimbursement need regular comparison.
Every infused dose carries a drug claim and risk
Office and ambulatory infusion centers buy expensive drugs up front, then bill for both the drug and its administration. A missed authorization or a site-of-care rule can turn one infusion into a loss larger than a month of office visits.
Book a demoWhat makes infusion billing high stakes
This page covers office-based and ambulatory infusion of biologics, immune globulin, and similar therapies. Chemotherapy has its own page, and home infusion follows separate supplier rules.
Authorizations and site of care
Many plans require prior authorization for each drug, and some steer patients to a specific site of care or a specialty pharmacy. An infusion given outside those rules can be denied in full.
Self-administered drug exclusion
Medicare Part B generally does not pay for drugs usually self-administered, even when given in the office. Checking the contractor's exclusion list before scheduling avoids a predictable denial.
Split the chair, the pharmacy, and the claim
Nurses run the chair, someone manages drug inventory and authorizations, and billing ties it together. Name an owner for each.
What the practice keeps
Clinicians document orders, administration times, and doses and approve codes. The practice manages drug purchasing, inventory, and specialty pharmacy relationships.
What Taiga takes on
Taiga drafts ICD-10 and CPT codes from clinical notes for physician approval, then handles claim submission and scrubbing, eligibility checks, denials and appeals, and patient statements.
Where a decision is needed
Prior authorization requests and renewals, manufacturer copay programs, and patients whose plan moves them to another site of care need a named owner.
Questions for an infusion fit call
Bring a de-identified infusion note, a paid drug claim, and an authorization denial. Leave patient details out of the booking form.
What do you infuse?
List your highest-volume drugs and conditions, and which are buy-and-bill versus supplied by a specialty pharmacy.
Who manages authorizations?
Describe who requests and tracks authorizations today, and how renewals are caught before they lapse.
How do you reconcile drug cost?
Explain how you compare what you paid for each drug with what payers reimbursed.
For practices where one denial is expensive
Useful to an independent infusion center or specialty practice whose drug denials and underpayments are big enough to notice but hard to chase.
No drug coverage or pricing advice
This page outlines billing questions only. It does not determine coverage for any drug, interpret a contractor's self-administered drug list, or advise on drug purchasing.
Questions about infusion billing
Can Taiga take on our infusion billing?
Infusion therapy is not on Taiga's published specialty list. Bring your drug mix and payers, and Taiga will tell you straight whether it fits.
How does Medicare pay for infused drugs in the office?
Most separately payable Part B drugs have a payment limit of average sales price plus 6 percent, published quarterly by CMS. Administration is billed separately from the drug.
Why was a self-injectable drug denied when we gave it in the office?
Medicare Part B generally covers drugs incident to a physician's service only when they are not usually self-administered. Contractors publish lists of drugs they treat as self-administered.
Do you cover chemotherapy infusion?
Our hematology and oncology page covers chemotherapy administration, drug units, and wastage. This page focuses on non-oncology infusion such as biologics and immune globulin.
Bring your drug and payer mix
Show Taiga what you infuse and who pays for it. You will get a direct answer on whether it fits.
System guides show possible billing handoffs, not proven specialty compatibility.