MARKET ACCESS CONSULTING

Understand the reimbursement sandbox as it relates to existing, new-to-market, or pipeline products or technologies.  Engage early in product development to identify internal and external strengths, weaknesses, opportunities & threats which can have long-lasting impacts on commercialization.

Increase market access opportunities by identifying Medicare and Commercial health plan medical policy coverage and/or outpatient fee schedule payment (i.e., PFS, ASP, HOPD, ASC, CLFS, DME) for your company’s products.

Set clear reimbursement expectations for reps & customers alike; improve use and customer account receivables (A/R) through education, provider denial assistance, evidence-based appeal templates, national or territory-specific rate sheets and reimbursement manuals.

Improve product sales and marketing opportunities by reducing market objections due to reimbursement or coverage.  Plan payer strategies to gain positive government and commercial insurance coverage for technologies typically deemed “experimental, investigational, or unproven."

Explore one-off projects to identify and solve coding, coverage, payment, modifier, claim billing and collection barriers.  Examples may include, but are not limited to: Coding Applications, Draft Medical Policies or LCDs, Comment Periods for Proposed or Final CMS Rules; researching industry trends in legislation and regulation; evaluating and optimizing reimbursement hotline operations including systems, processes, and improvements.