How Reimbursement-Savvy Sales Personnel Increase A Company's Bottom Line

By Edward Black, founder and principal, Reimbursement Strategies

By Nancy Kolb, Reimbursement Strategies, LLC

In this series of articles, we have focused on the importance of reimbursement to a company’s commercial success. The overall business plan must have reimbursement as an integral component at the strategic planning level. Additionally, reimbursement must be coordinated with the regulatory, clinical studies, and commercialization plans, including marketing and sales. This article presents the role of sales personnel in implementing a successful reimbursement plan, and discusses the sales force’s need to understand reimbursement sufficiently to be a resource for their customers.

Among the fundamental skills for most successful sales personnel is good verbal communication, allowing them to persuade a customer to buy a product. However, one of the best ways to achieve silence at a national sales meeting is to introduce the topic of reimbursement, an act usually followed by audible groans, eye rolling, and body language that conveys extreme skepticism.  Questions then follow: “What does this have to do with making the sale?” “I make the sale based on the product, so why do I need to know about the customer’s payment?” “Why can’t someone at the home office answer my customer’s questions?”   

Sales personnel often think that reimbursement is too complex, even though they undergo rigorous technical product training to become proficient in explaining product aspects that benefit customers and their patients. Or, sales personnel simply may not understand the relevance of reimbursement to their sales success, mistakenly thinking that their responsibility ends with their sales presentation to the physician.

This attitude is short-sighted, though. While good sales people may have adequate product sales when selling on the basis of features and benefits to the physician, great sales people increase their sales by selling to the entire practice. Initial sales may be fine for both groups of sales professionals, but those sales are likely to decrease if the customer is not getting paid by insurers, the payment is inadequate, or the path to payment is too difficult/takes too long.  

Learning about reimbursement, and honing the ability to have an intelligent and informed conversation about it, can improve a sales person‘s access to an account. They become a valuable resource to the account, one who cares about the customer’s bottom line, as well as their own commission. This can ultimately result in improved sales performance.

Thus, sales personnel should be knowledgeable about the following aspects of reimbursement:

1. The understanding that fluency in reimbursement can improve their own bottom line, as well as the company and customer profit.
2. Basic reimbursement information, including coding, coverage, and payment — and why all three are important to customers.
3. The types of insurance payers – commercial payers, Medicare, Medicare Advantage, Medicaid, etc., and how a patient’s insurance can influence payment to healthcare providers.
4. The sites of service in which company products are used, and how site of service can affect the amount a customer may be paid by an insurance company.
5. The specific codes used to report the products, including CPT codes to report procedures and services, ICD-10 codes to report common diagnoses associated with the procedure or product, and HCPCS codes to report supplies or drugs.
6. An understanding of pre-authorization, especially if it is necessary before the patient can have the procedure performed, or receive durable medical equipment for home use.  For example, expensive implantable devices may require a physician to obtain “permission” (pre-authorization) from the patient’s insurer to ensure payment.
7. Resources the company has developed to help customers navigate reimbursement for its products. Examples include reimbursement guides, websites, a reimbursement hotline, links to professional society sites, a reimbursement FAQ, tools for pre-authorization, claims appeals, and sample letters of medical necessity.
8. Sufficient reimbursement expertise to recognize when a customer’s reimbursement issues should be referred to other company personnel, or to an outside resource for expert consultation.

Sales personnel can use reimbursement knowledge to expand customer call points within an account.  This may include talking to the office manager, CFO, billing personnel, or the accounting department.  When the sales person understands the customer’s business model, s/he can demonstrate how a product could contribute to the practice’s financial, as well as clinical, success. As access into accounts becomes more restricted, these additional touch points within an account can help to open doors. For example, the office manager may arrange a meeting with the sales person to discuss product reimbursement with the physician.

Along with teaching the sales force basic reimbursement information, the company should share its plan to maintain, expand, or improve coverage. This is especially important if there are reimbursement obstacles that can slow adoption of procedures or products. Customers may become frustrated if pre-authorization or claims are denied, and prolonged appeals are necessary for payment. 

However, a sales person with a good relationship within an account may be able to enlist customers to assist with reimbursement strategy. For example, a physician may be asked to meet with a payer medical director to discuss how a procedure may positively impact patient care. Some practices will be more willing to process appeals for denied claims on behalf of patients through multiple levels of denial and appeal.  Other practices may be willing to advocate for support at the professional society level to engage with payers.

Bottom Line: Understanding how medical device reimbursement impacts a customer’s bottom line can positively impact both the sales person’s and the company’s bottom line. 

About The Author

Nancy Kolb, MSN, is a senior advisor at Reimbursement Strategies, LLC. She has worked in the international medical device community for 30 years, serving in reimbursement, marketing, and executive positions.

Ms. Kolb specializes in strategic business and marketing plans that incorporate reimbursement issues for entrepreneurial and established companies. Prior to joining Reimbursement Strategies in 2014, her roles included VP of Marketing & Reimbursement at Uroplasty, Inc., VP of Marketing at Inlet Medical, and various business unit positions at Gyrus Medical.

Ms. Kolb has authored, co-authored and supported publication of over 30 manuscripts in professional journals.  She is one of the founders of the Society of International Gastroenterological Nurses and Associates, a past president of the U.S. Society of Gastroenterology Nurses and Associates, and a member of the Society of Urology Nurses Association.