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Welcome to Global Integrated Reimbursement Services’ blog. The purpose of our blog is to allow access to a repository of issues that our company tracks regarding the reimbursement for pharmaceuticals, medical devices, diagnostics, biologics, and biosimilars. Also, it shows you how we can assist you in these areas.

Most Recent Articles

GIRS Provides Road Maps of Successful Marketing and Reimbursement Strategies

Posted by on Jul 26, 2016 in Coding & Billing | Comments Off on GIRS Provides Road Maps of Successful Marketing and Reimbursement Strategies

GIRS Provides Road Maps of Successful Marketing and Reimbursement Strategies… Recently GIRS completed several Landscape Assessments to help our clients develop the foundation for their marketing, clinical outcomes, and reimbursement strategies. Some typical impactful outcomes are: GIRS researched the key payer markets and providers to determine the medical device coding, coverage, and reimbursement implications and provider perspectives of two implants being packaged with surgical instruments or provided separately. This helped our client to decide how best to package their medical device implants to meet the needs of the providers as well as insurers. GIRS researched the Medicare National Non Coverage for a Biologic Product as well as Commercial Payer and Workers’ Compensation coding, coverage, payment and clinical outcomes requirements in each payer market. The resulting innovative payer strategies are being implemented now for each key payer market. GIRS researched the coding, coverage, payment and evidence requirements for a dialysis drug. This lead to the development of a Billing Guide to assist accounts with potential coding and billing information and a payer dossier for future payer education and coverage initiatives. Are you getting ready to develop a new medical technology-if so it is best to conduct a Landscape Assessment before developing your innovative concept to understand the payer requirements for your type of technology and...

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GIRS tracks insurance mergers to determine impact on coverage of client medical technologies

Posted by on Jul 26, 2016 in Payer Coverage | Comments Off on GIRS tracks insurance mergers to determine impact on coverage of client medical technologies

GIRS tracks insurance mergers to determine impact on coverage of client medical technologies The U.S. Justice Department is likely to file lawsuits this month to block Anthem’s $53 billion acquisition of Cigna Corp. and Aetna’s $37 billion deal for Humana. Our Payer Advocacy Compass™ (PAC) team is monitoring these merger cases to ensure that our clients, their sales force, and accounts will be informed in a timely and competitive manner of any medical policy coverage changes from these potentially impactful mergers. Please review the testimonials for our work at:...

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Case Example: GIRS Increases the Medicaid Managed Care Market Share of our Clients in 2015

Posted by on Oct 16, 2015 in Payer Coverage | Comments Off on Case Example: GIRS Increases the Medicaid Managed Care Market Share of our Clients in 2015

Molina Healthcare’s revenues increased within the first quarter as a direct result of the ACA expansion of Medicaid and private health coverage. Molina has expanded Medicaid under the ACA in California, Illinois, Michigan, New Mexico, Ohio & Washington. Molina also offers Exchange plans in 9 states. In 2015, we increased our clients’ market share in the Molina states by improving patient access to breakthrough medical technologies. If the Medicaid Managed Care market is an important markets for your medical...

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Medicare Sets Goal of 80 Percent Medicare Traditional Payment to Alternate Payment Methods by 2018

Posted by on Jan 27, 2015 in Payment System | Comments Off on Medicare Sets Goal of 80 Percent Medicare Traditional Payment to Alternate Payment Methods by 2018

  Medicare has introduced several alternatives to the traditional payment system such as Accountable Care Organizations, Hospital Value-Based Purchasing, Hospital Readmission Reduction Program and other quality measured payment methods over the last few years. Currently, 20% of total Medicare payments are provided by these alternative payment methods. Medicare has set new goal dates and percent of use of these alternative payment methods as: • 2016 30% payment by alternative payment methods • 2018 50% payment by alternative payment methods...

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GIRS Completed the Economic Gardening Trial Program to Initiate Further Growth

Posted by on Oct 16, 2014 in News | Comments Off on GIRS Completed the Economic Gardening Trial Program to Initiate Further Growth

Due to a successful business model, intent and capacity for growth, and service to external markets outside of Memphis and Shelby County, in 2014, Global Integrated Reimbursement Services Inc., (GIRS) was acknowledged and selected this year by the City of Memphis, TN and Shelby County, TN to participate in the Economic Gardening Trial Program through the Mayor’s Innovation Delivery Team and its Economic Development Growth Engine (EDGE). The GIRS President and staff worked with the experts assigned to the...

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2014 Landscape Assessment and Coding Strategies: Provided Effective Coding Strategies of a Device for Gastroenterology Supply Reimbursement

Posted by on Oct 16, 2014 in Coding & Billing | Comments Off on 2014 Landscape Assessment and Coding Strategies: Provided Effective Coding Strategies of a Device for Gastroenterology Supply Reimbursement

Global Integrated Reimbursement Services Inc. (GIRS) got a referral from a former contractor because they considered us to be “the best in the business.”  The company had two Randomized Control Trials (RCTs) that were being conducted but could not find any existing HCPCS code for the device.  The client needed a high level Reimbursement Landscape Assessment that focused on coding and reimbursement strategies to be completed in two weeks to present to investors.  We reviewed the Product information and...

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2014 Hotline Success Case Study 4: Sales Force Education

Posted by on Oct 16, 2014 in Hotline Successes | Comments Off on 2014 Hotline Success Case Study 4: Sales Force Education

  A sales representative from Illinois contacted the GIRS InContact Reimbursement Line™ to obtain the product billing and diagnosis codes for a device / biologic combination so that she could relay them to an account.  The counselor informed this  caller that the helpline cannot provide diagnosis codes; it is the responsibility of the providers to make that determination. The counselor provided an overview of the approved Product coding.  The counselor asked for permission to speak directly with the account...

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