1) Not Listening to HCP needs

Field reimbursement manager speaking on the phone with a healthcare provider.

Health care providers have direct patient interaction and drive the access to medications. Therefore, field reimbursement teams should be in tune with their needs and their frustrations as the first gatekeeper to the medication is the provider. Education and assistance are keys to having the support system for the provider. The provider will not want to deal with delays of care or administrative headaches.

You are the resource that will make sure there are no “surprises” that pop up during the process. Learn what the provider needs and be able to provide the answer, but to do that – you have to listen carefully.  

Field reimbursement manager looking over at something with patient files in the background.

2) Toeing the Compliance and Ethics Line

There are many tactics for understanding the stakeholders involved in patient care and access, but none of these tactics should go against federal law or the pharma code of ethics. Ensure your team has the highest level of integrity and maintains patient privacy. Consequently, field reimbursement teams should not have access to sensitive patient information.  

3) Misunderstanding Federal Health Plans

As of July 2020, the CMS data shows that 17.7% of the GDP is spent on the National Health Expenditure and 21% of that spend is dedicated to Medicare. This validates the growing concern for stakeholders in healthcare. With almost 1 in 5 people covered by Medicare, it would behoove all field reimbursement managers to understand federal health plans better than anyone. Despite this, there is still confusion. 

4) Not Understanding the Difference between Pharmacy and Medical Benefits

Recently, everyone is talking about specialty products and the specialty spend, but it can be confusing to be able to figure out if these novel products are in the pharmacy or medical benefits. In order to prevent confusion, you need to know the situations in which one or the other applies. Not only that, but understanding how to bill for specialty products will be important.
(Remember in infusion billing: 16 minutes = 1 hour, but so does 1 hour, 16 minutes)

Field reimbursement manager standing confidently.

5)  Missing Opportunities to Be the Expert

The goal of a field reimbursement manager is to become the expert for the healthcare team. Instead of reaching out to them to figure out how you can help, you should be turning it around to be the expert they turn to; making yourself an asset to healthcare providers will help build trust.  Most importantly, it can help save the healthcare practice time and money and improve patient access to much needed medications. Physician offices don’t want to be spending hours doing prior auth claims and that’s where you can help by becoming an expert in topics such as prior authorization, market access and reimbursement.

The National Board of Prior Authorization Specialists (NBPAS) is an ACMA company focused on establishing benchmarks of excellence for the life sciences and healthcare industries. We specialize in improving prior authorization performance by reducing denials and increasing revenue retention associated with reimbursement claims. Set your field reimbursement team apart with prior authorization and reimbursement knowledge that can raise your bottom line through the Prior Authorization Certified Specialist program (PACS).