The GIRS Payer Advocacy Compass® (PAC) created a reimbursement strategy for a client’s account when they reported that they were unsuccessful in getting certified by a key Medicaid payer market to begin billing for our client’s Product.
The PAC team initiated a meeting with the provider and a sales representative in order to understand the case. Once the situation with the provider was clarified, the PAC team formed a two-fold plan of action to address the issue.
As the provider was having difficulty getting the payer accept the correct IRS documentation for being set up as a provider, the PAC team first put the provider in contact with a CPA they knew from previous work to contact the IRS to identify and obtain the right documentation required by the payer.
Then as a follow-up, the PAC team used existing contacts within the payer’s organization to educate them about the product and find out what was lacking in the documentation that the provider sent the payer.
After receiving an update from the CPA, the PAC team then followed up with the CPA and provider to ensure the provider received the correct paperwork from the IRS to send to the payer in a timely fashion.
As a final step, the PAC team consulted with the payer and received a detailed response outlining their process, contact information, and next steps should a similar situation occur in the future.
Because of the expediency of the GIRS PAC team, our client’s provider received the correct paperwork for being set up for billing in a timely fashion and had the matter resolved conclusively.
Are your accounts having difficulty in gaining appropriate reimbursement? Do your accounts keep experiencing denials on claims because of incorrect or insufficient documentation? Do your accounts experience push back from payers in any other area?
Let the GIRS PAC team help you get the information you need as we have with our previous success cases.
For more information on our PAC team’s methodology or assistance in a similar situation, email us at info@girsinc.com or call us at 901-834-9119.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
About GIRS
For more than 19 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.