Expert Advice, Articles & Blogs XiFin EXCELLENCE
Building a Strong Foundation: How Market Access Teams and RCM Partners Drive Coverage Success (Part 1 of 3)

Building a Strong Foundation: How Market Access Teams and RCM Partners Drive Coverage Success (Part 1 of 3)

January 23, 2025

Market access is a cornerstone for healthcare providers striving to achieve widespread adoption of their tests and services. However, growing complexities in billing processes and payor policies create significant challenges. Providers must navigate a labyrinth of payor requirements, changing policies and behavior, and regulatory hurdles. For these reasons, a robust market access strategy and a reliable revenue cycle management (RCM) partner are no longer optional—they are essential.

In this first installment in a three-blog series, we’ll introduce several important ways your RCM partner can support your market access goals.

The Three Core Pillars of Market Access

A market access team is tasked with securing consistent coverage across payors, negotiating contracts, and ensuring reimbursement aligns with the value of their diagnostic services. The core pillars of a successful Market Access approach include:

  • Medical Policy — Does the test/procedure meet clinical utility?
  • Claim Requirements — Is the claim coded correctly, and does it meet payor requirements?
  • Network Access — Does the test/procedure add value to network members? Is there justification for in-network coverage?

Too often, Market Access teams face significant barriers to successfully navigating these key pillars:

  • Underfunding and Siloed Operations: Market access roles are frequently underfunded, leading to split responsibilities and reduced impact. Also, in some organizations, there is a lack of collaboration between the market access team and other teams, such as the revenue cycle management and finance teams who have data and expertise that can be leveraged to better achieve payor coverage expansion goals.
  • Inexperience: Staff often lack the necessary relationships and skills to negotiate effectively with payors.
  • Data Gaps: Teams often lack industry benchmarks and struggle to provide actionable insights to support coverage and reimbursement efforts.

These limitations can marginalize the role of market access teams, hindering their ability to achieve expanded payor coverage and consistent reimbursement rates.

Investing in Expertise: The Key to Success

For healthcare providers to unlock their full potential, they must invest in experienced market access professionals who are equipped with skills in:

  • Payor Relations and Contracting: Building trust and credibility with payors to negotiate favorable terms
  • Medical Policy Navigation: Ensuring compliance with complex medical policies to minimize denials.
  • Cross-functional Collaboration: Aligning market access strategies with commercial, RCM, and finance teams.

The Value of Collaboration

Market access teams cannot operate effectively in isolation. To enhance their success, they must collaborate with RCM, commercial (e.g., sales, and client service), and finance teams.

  • RCM Teams: Offer coding expertise, payor-specific billing knowledge, and advanced denial management.
  • Finance Teams: Conduct cost-of-goods analyses and provide insights into client profitability.
  • Commercial Teams: Focus on driving growth and enhancing client experiences, creating synergies with market access efforts.

Seasoned market access professionals are indispensable in navigating payor dynamics. By focusing on relationship-building and policy expertise, these teams can secure better coverage and streamline reimbursement processes.

The Critical Role of RCM Partners in Achieving Market Access Goals

An effective RCM partner can help bridge the gaps that market access teams typically face. Here’s how:

  • Data Insights: RCM partners provide detailed analyses of reimbursement trends, denials, and payor-specific behaviors.
  • Streamlined Billing: By optimizing claim submissions, RCM partners reduce the likelihood of errors and accelerate payment timelines.
  • Policy Compliance: Ensuring claims align with the latest payor requirements minimizes the risk of denials and audits.

The increasing complexity of healthcare billing and market access necessitates a strategic, collaborative approach. Investing in seasoned market access professionals and partnering with a robust RCM provider enables healthcare organizations to:

  • Achieve and expand payor coverage,
  • Streamline reimbursement processes and
  • Enhance patient access to critical diagnostics.

Providers can unlock new opportunities and sustain long-term growth in a challenging healthcare landscape by building a solid foundation and fostering cross-functional collaboration. In our next installment of this series, we’ll explore data-driven strategies to overcome common market access challenges.

For more information about XiFin-recommended market access best practices, watch our on-demand webinar, “From Market Access Through Reimbursement: Your Playbook to Maximize Revenue and Cash Flow.

You can read part 2 and 3 of the series below:

HospitalLaboratoryPathologyPrior AuthorizationRevenue Cycle Management

Sign up for Blog Alerts