Do You Speak CPT? DRG? ICD-10? Learn Why It Will Make You a Better Healthcare Marketer

Healthcare claims data are an excellent resource to deeply understand how facilities and physicians deliver care. Healthcare codes allow you to better understand your market, target new opportunities, and segment your campaigns with precision.

​To fully leverage this invaluable resource, it’s helpful to know how the underlying mechanics of healthcare billing and reimbursement work.

Healthcare providers, including facilities and physicians, by and large get paid through insurance programs funded by private insurance (i.e. UnitedHealthcare, Aetna, BlueCrossBlueShield, etc), federal programs (i.e. Medicare) or state programs (i.e. Medicaid).
Providers must submit claims for all services rendered in order to be paid or reimbursed for the care delivered. It’s the information found on these claims that can be leveraged to understand who is treating what types of patients and how those diseases are being addressed with various interventions whether it procedures, prescriptions or any of the many combinations of possible treatments..

More specifically the information found on insurance claims can tell you:

• Provider name and contact information
• Where services were rendered
• Which diagnoses were treated
• Which procedures were delivered
• For how long the patient was treated

In general physicians get reimbursed based on each of the services delivered. In contrast, facilities expect to get paid based on a bundle or grouping of the services delivered. A bundle is assigned based on the underlying diagnoses and procedures delivered. These bundles of care represent additional codes that are useful for investigating utilization and care treatment patterns. The most common codes marketers will encounter are summarized in the table below.

ICD-10-CM: International Classification of Diseases Clinical Modification, version 10
ICD-10-PCS: International Classification of Diseases Procedure Management system, version 10
CPT: Current Procedural Terminology
DRG: Diagnosis Related Group
APC: Ambulatory. Payment Classification

How can I use healthcare billing and diagnosis codes to identify providers?

By leveraging knowledge of these codes, you can build a profile of the various types of physicians or facilities you are trying to target.  These healthcare codes allow you to get super granular and find the exact providers your sales team members should be talking to. It's one of those rare win-wins where your sales team is more effective and your messages will resonate more with your prospects given the laser focus your applied to your segmentation.

Check out two examples of how you may build out a physician segmentation strategy based on very specific signals of how those doctors practice medicine.

​Example 1: Focus on docs who use diagnosis specific diseases AND perform a range of procedures

Example 2: Raise awareness focusing on docs who use select products while excluding certain diagnoses

Carevoyance was created to enable medical device companies to transform their commercialization strategies. Sales Ops, Marketing and Sales Reps Marketing teams become tightly coordinated and deliver more value with the most relevant data and easy to use tools to build and execute sophisticated physician campaigns.

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