The GIRS Payer Advocacy® (PAC) Team began working with a key regional payer in June 2018 to assist with the implementation of positive coverage for a medical device that was experiencing a high volume of claims denials for coverage and payment. The PAC team conducted extensive research that involved the review and analysis of pertinent medical policies, and discussions with the payer to educate them about the payer dossier and value proposition of the product.
As a result of the PAC team’s work with the payer, the Medicare Advantage plans implemented positive coverage. The team is continuing to work to implement positive coverage for other plan types under this payer by the next review period.
In addition to conducting payer research, policy analysis, and developing comprehensive payer advocacy strategies to enable positive coverage for our client’s product, the PAC team developed tools that educated our client’s sales force and key stakeholders of the new, positive coverage. Further, the PAC team made strategic recommendations to educate and support providers in ensuring appropriate billing for their Medicare Advantage patients.
If your accounts are experiencing claims denials for your medical device, drugs, biologics, or diagnostics, or if you need to improve the market uptake and patient access in key markets, our PAC team can assist you to meet your company goals.
To implement successful market access strategies, the GIRS Value Discovery Landscape Assessment® team can also conduct a Reimbursement Landscape Assessment to develop payer-desired strategies with clinical outcomes experts, coding experts, policy staff, reimbursement lawyers, and a panel of current insurer medical directors. This work will provide you with foundation reimbursement strategies that will influence and coordinate your clinical outcomes, marketing, and reimbursement strategies to result in the best market access outcomes. The PAC team can then implement these strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. Please contact us by email or call us at 1-844-514-4477. Also, follow our LinkedIn Company Page for more bi-weekly news on reimbursement trends, milestones, and achievements.