Real-world evidence (RWE) provides insight for strategic coding initiative of medical device

Client background

Baker Tilly worked with senior leaders of a circulatory support device company to generate real-world insights on provider billing trends associated with their hemodialysis reliable outflow (HeRO) device. The client was a large, multinational circulatory support device company with more than 200 patents, 500 clinical publications and products that are featured in 10 clinical guidelines

The business challenge

The client wanted to launch a provider billing initiative to ensure the organization’s device was being properly captured in billing data. The client needed to comprehensively understand how different procedures involving their HeRO device were being billed by providers.

The Baker Tilly approach

Baker Tilly analyzed real-world data (RWD) to assess the total and line-item costs associated with the use of the client’s product device to generate insights on provider billing trends. The RWD was used to determine if providers were under or inappropriately billing for procedures involving the client’s product. Baker Tilly analyzed long-term total cost and line-item billing trends of the top 20 providers utilizing the client’s product.

Business impact

The billing analysis enabled the client to comprehensively quantify the impact of provider billing errors and utilize those insights to support the recently launched provider billing initiative. Through the insights generated by Baker Tilly’s analyses, the client was able to have meaningful, billing-focused discussions with the Centers for Medicare & Medicaid Services (CMS), as well as providers, to demonstrate the importance of appropriate billing practices.

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