A quarterly review is only as useful as the numbers on the table. These are the ones worth bringing for an allergy and immunology practice with a biologics program, and the question each one answers.
Your biologics program
- Patients by medication
- How many patients are on each biologic, how many started this quarter, and how many stopped, with the reason.
- Units administered
- By medication and strength. This is also what you report for rebates, so the two numbers should agree.
- Authorizations coming due
- Which approvals expire next quarter, and whether the updated clinical notes are already in the chart.
Discontinuations deserve a closer look. A patient who stopped because of cost or coverage is a different problem from one who stopped because the drug didn’t work. The first can often be solved with a new benefit check, a different channel or copay help.
Claims and collections
- Denials by reason
- Group them by the payer’s reason code. A cluster usually points to one fixable cause: an expired authorization, a units error, a missing NDC.
- Days in accounts receivable
- And the share of balances older than 90 days. Old balances are the hardest to collect; know which payers they sit with.
- Payments against expectations
- Compare what each payer paid with what its contract or fee schedule says it should have. Underpayments are quiet.
For biologics, add the margin per medication by payer: reimbursement against your acquisition cost per unit. The same drug can earn money with one payer and lose it with another.
Access and workload
- Time to first dose
- Days from the prescription to the first injection. Delays usually sit in benefit checks and prior authorizations, and patients notice them.
- Authorizations in flight
- How many were submitted, approved, denied and still pending, and how long approvals took with each payer.
- Staff time
- Who spends their week on benefit checks, authorizations and payer calls, and how far behind they are.
Inventory and rebates
- Stock on hand
- What’s in the refrigerator, what expires before it will be used, and what was wasted this quarter.
- Rebates
- The units you reported, the rebate on each medication and the check date. If something looks off, raise it while the quarter is fresh.
How to run the meeting
Send the numbers ahead, so the hour goes to decisions rather than reading. Compare each figure with last quarter and with the same quarter last year; allergy and asthma volumes are seasonal, and a quarter-over-quarter drop can be nothing more than spring ending.
Keep the agenda short: what changed, why, and what you’ll do about it. End with three or four decisions, each with an owner and a date. The next review starts by checking them.
“What changed, why, and what you’ll do about it.”
For Medico members
Quarterly business reviews are part of Medico membership: your numbers, reviewed with the Medico team every quarter. Your reported units and rebate statements are already in your portal. Bring the rest of this list, and the questions it raises.
