Allergy & Immunology Accounting Software

Accounting in a Allergy & Immunology Practice

Two kinds of inventory sit in an allergy practice. One is biologics, such as omalizumab, mepolizumab, benralizumab and tezepelumab, bought ahead and billed after each dose. The other is allergen extract, bought in bulk and mixed into patient vials, with its cost paid back through 95165 doses rather than a drug line. Unlimited Systems keeps the purchase record for each drug and compares it with the units given and billed. Biologic units bought but never billed show up as an exception. For Medicare, a dose from a single-dose container bills on one line, with any discarded amount on a second line with JW. Before a biologic is given, the contracted rate can be checked against acquisition cost, so a dose that would lose money is flagged. Payments, adjustments and drug costs post as journal entries to the general ledger. Leaders see margin by drug, payer, location and service line, from testing to shots to biologics.

Why Is Accounting Different in Allergy & Immunology?

Buy-and-bill turns the practice into a drug buyer. A biologic is paid for when it arrives, often well before the payer pays for the dose. If the payer pays less than the drug cost, or a dose is never billed, the loss lands on the practice. Accounting in an allergy practice has to follow each unit from purchase to payment, not just book a monthly drug invoice.

Antigen extract works another way. The practice buys concentrates and diluent, mixes patient vials, and is paid for preparation through 95165 doses. Medicare counts doses by the 1 cc aliquots a vial holds. It also pays only for a reasonable supply of antigens, meaning no more than a twelve-month supply prepared at one time. Extract cost has to be weighed against those dose payments, not against a drug line that does not exist.

Medicare waste rules add a compliance layer. Under Part B, single-dose container drugs need JW for a discarded amount or JZ when nothing was discarded, and the discarded amount must be documented in the record. CMS also expects accurate purchasing and inventory records for drugs billed to Medicare. Accounting that keeps purchases, doses and waste together supports both the books and an audit.

What Allergy & Immunology Accounting Software Handles

Buy-and-bill biologics (J2357, J2182, J0517, J2356)

CMS lists these codes as single-dose container drugs under its JW and JZ policy. Each purchase of omalizumab, mepolizumab, benralizumab or tezepelumab is matched to doses given and billed, and units bought but not billed show as an exception. (CMS: Discarded Drugs and Biologicals, JW Modifier and JZ Modifier Policy HCPCS Codes)

JW waste lines for Medicare

When part of a single-dose container is discarded, Medicare wants two lines: the units given with no modifier and the discarded units with JW. The discarded amount is documented and kept with the cost of the container. (CMS JW and JZ Modifier Policy FAQs)

JZ when nothing is discarded

When no drug is discarded, the Medicare drug line carries JZ. The modifier and units are stored with the dose, so waste totals by drug can be reported for review. (CMS JW and JZ Modifier Policy FAQs)

Overfill

CMS bars billing for overfill, and JW must not be used for it. Only amounts up to the labeled size of the container count toward billed or discarded units. (CMS JW and JZ Modifier Policy FAQs)

Antigen extract and 95165 doses

Extract is not billed as a drug line. Its cost comes back through 95165 doses, so extract and supply spend are compared with dose payments by month and location. (Medicare Claims Processing Manual, Chapter 12, Section 200: Allergy Testing and Immunotherapy)

Reasonable supply of antigens

Medicare covers only a reasonable antigen supply, defined as no more than a twelve-month supply prepared for a patient at one time. Vial build records show what was prepared, so billed doses stay inside that supply. (Medicare Benefit Policy Manual, Chapter 15, Section 50.4.4.1: Antigens)

ASP-based Medicare drug payment

Medicare Part B drug rates come from the quarterly ASP file. Each quarter's rate is compared with what the practice paid, so a drug whose payment falls below cost is visible. (CMS ASP Pricing Files (Medicare Part B drugs))

How Does Allergy & Immunology Accounting Software Work?

1. 1. Record the purchase

   Each biologic purchase is logged with drug, units and cost. Extract and supply purchases are logged to the immunotherapy cost center.

2. 2. Check margin before the dose

   Before a biologic is given, the contracted rate is checked against acquisition cost. A dose that would lose money is flagged while there is still time to act.

3. 3. Match doses to claims

   Units given, units discarded and units billed are compared for each drug. Unbilled doses go back to charge assembly so they can be billed.

4. 4. Post payments and adjustments

   Payments from allergy payment posting post as revenue against the drug or service line. Contractual adjustments and write-offs post with them.

5. 5. Close by entity and location

   Journal entries roll up by Tax ID, location, provider and service line. The general ledger export goes to the practice's accounting system for the close.

Allergy & Immunology Accounting Software vs. Generic Software

Who Uses It in a Allergy & Immunology Practice

• Controller: Journal entries for payments, adjustments and drug costs, split by Tax ID and location, ready for the month-end close.
• Practice administrator: A list of biologic units bought but not billed, and waste totals by drug, before an auditor asks for them.
• Physician owner: True margin by drug, payer and service line, with trends shown in allergy practice analytics.