Liz Paulson

Posted on: November 8, 2018

I’ve spent my life helping life sciences organizations integrate data and build strategies on the insights that data provides. I always take the time to educate them on how not all data is created equal. Once you’ve identified the best source of claims data – make sure your organization knows what to do with it.

Recently I’ve been consulting with my customers on the importance of tapping into 835 remittance claims data when making financial and brand decisions. Medical remitted claims data has just recently become more accessible to the life sciences industry and its power is transformative. It provides insights into how a brand is performing from a utilization and reimbursement perspective. That means as new products are being developed and new markets explored, you don’t have to build plans on educated guesses. I thought it might help some organizations out there to understand what I consider to be the top 5 ways remittance data insights can be applied to increase market share and profit.

  1. Compare how different payers reimburse for procedures and products.

Benchmark your product against others and make sure you’re not under- or over-pricing yours.

  1. Identify discrepancies in reimbursement rates between providers.

All providers are not paid equally. Therefore, when you have information that reveals different reimbursement rates for your product, you can inform providers who are receiving less and empower them to renegotiate their contracted reimbursement rate. With higher reimbursement rates, they’ll be more likely to prescribe your product.

  1. Educate providers on billing practices that maximize reimbursement.

Variables, like the codes used and the facilities administering the treatment, can result in different reimbursement rates. If you can help providers maximize reimbursements, they’re more likely to use your product.

  1. Track pull-through over time.

Determine whether your product is consistently reimbursed at the same rate or if it fluctuates, and use that information to your advantage.

  1. Recognize market changes.

Be proactive in responding to trends.

If your organization has not looked into leveraging remittance data – it should.

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LexisNexis® MarketView Provider Reimbursement Insights leverages the industry’s most current remitted claims data for use by life sciences companies. Learn more here.

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