coding & coverage analysis
THINKING OUTSIDE THE REIMBURSEMENT BOX
Situation
A client’s novel pulmonary technology showed high potential as a diagnostic or monitoring device. However, the product was not yet supported by insurance coverage or billing codes.
Our Role
We conducted a thorough coding and coverage analysis.
Outcome
Our consultants’ recommendations formed the basis for a multi-faceted positioning strategy – including identification of clinical trial endpoints and advocacy among commercial insurance providers.
Impact
After verifying that reimbursement would not be available immediately, we developed a two-pronged strategy to generate short-term and long-term revenue streams:
- Focus early-stage sales on targeted sites of service where lack of reimbursement wasn't a barrier to entry.
- Simultaneously pursue reimbursement by initiating a trial for a small, well-defined market segment, where the probability of success seemed most likely.