Reimbursement Strategies: A rock-solid market and reimbursement access strategy is crucial to attaining commercial success. Challenges and barriers surrounding a new or established technology can be multi-faceted.
Our consultants will partner with you to help build and navigate a path for you to the challenges and or barriers your unique technology faces, not just for new products but for established products as well. We understand the conflicting objectives and concerns of a multitude of stakeholders.
Where can potential problems reside?
- Clinical Literature- is there sufficient US-based literature and clinical outcomes identified? What is the magnitude of the literature available? Is the sample size in the clinical literature of sufficient magnitude? Can you product clearly demonstrate clinical utility? Cost-effectiveness? Clinical-effectiveness, equal to/greater than alternative therapies?
- Is the technology expensive? Highly visibility? Potentially large market?
- What current policies exists that may negate coverage? Payment?
- What codes are currently utilized? Will the product require a distinct, new code?
- Do the physician specialty associations understand and use your product?
- Do payers understand or know anything about your product?
Market Analysis: Policy and Payer Development
RS has significant and extensive experience working with a multitude of payers and their respective staff: Medicare, Medicaid, Commercial and Managed Care. We know how payers think and understand their approach. We provide the following services:
- Policy Analysis and the evaluation of the impact of an insurer’s coverage decision to your product
- Identify insurers you should meet with when necessary, based on a number of factors
- Identify when you should meet with the insurers
- Attend meetings on your behalf, if necessary and/or appropriate
- Reimbursement Strategies can prepare White Papers and presentations to insurers and other stakeholders
Product Value Dossiers
What information is important and valuable to Payers, Physicians and Patients?
- We can help you craft , plan and deliver your product’s value message
- Decision-makers have needs that may not be communicated to you, but these needs/values influence product adoption
Provider and Sales Force Reimbursement Education and Training
- Develop educational programs to the appropriate providers and Sales Force. Too often hospitals and physicians must administer the billing services but do not know the appropriate ICD.9, CPT or HCPCS codes or the appropriate places of service where technology can be used
- Sales Force also, at times, operates under the same constraints. Effectively training your sales representatives in reimbursement is imperative to successfully market your product to stakeholders. If they cannot communicate on reimbursement and/or understand what questions the providers are asking, or recognize the importance of a particular question, you can decrease your economic effectiveness in the marketplace. Your sales reps are interacting regularly with your hospital and physician customers. Are your sales representatives trained in reimbursement?
- RS can develop a comprehensive sales training reimbursement program
- RS can develop Sample Letters to be utilized by providers
- RS can develop Reimbursement Billing Guides and Coding Forms
Coding (diagnosis, procedural and technology) is such an important part of the reimbursement landscape, Reimbursement Strategies researches all code options to determine if established codes are appropriate and available, or if new and more specific coding will be required. In addition, RS has access to Certified Professional Coder consultants that provides our clients with the most knowledgeable support available when assessing coding questions.
New coding is at times required, due to the innovative nature of the technology.
- An application to the appropriate coding entity must be prepared
- This process can be time consuming and requires the insight and experience of staff familiar with the process
Our firm has considerable experience with CPT, ICD-9-CM diagnosis and procedure codes, Ambulatory Payment Classification, New Technology C-Codes, and HCPCS applications. We write or review and assess applications and solicit specialty physician associations input as necessary. This process provides critical feedback to clients on this essential step in the evolution of a reimbursement building block. We interact with the appropriate advisors throughout the application process.