Reimbursement
Payer and Market Research
It is beneficial for manufacturer’s to have an understanding of the current reimbursement climate for their product. Performing the necessary payer and market research early in the product development phase allows the opportunity to make informed decisions regarding coding strategy, evidence generation and can help to identify potential hurdles to reimbursement and payer coverage.
Physician/Facility Coding and Reimbursement Strategy
Coding methodologies and reimbursement pathways are dependent on a variety of factors and sometimes require the establishment of a new pathway to reimbursement. Our coding and reimbursement strategists will create a detailed coding and reimbursement strategy for use by both physician and facility stakeholders as well as manufacturer marketing/sales teams.
AMA CPT Code Application Submissions
The AMA CPT Coding Application is a lengthy submission process that requires and understanding of the current CPT Code Set as well as the application requirements for the various types of CPT code categories. Our coding experts have valuable experience that can guide Manufacturers of new and emerging technologies/procedures in obtaining a new CPT code for physician reporting.
Payer Coverage Policy Reconsideration Requests
Payer coverage policies are often not in line with the adoption of newer procedures and treatments. Overturning these negative payer coverage policies requires payer advocacy. Our knowledgeable team can review products/procedural techniques and communicate to payers the information necessary to make an informed decisions on coverage policy recommendations and reconsideration requests.
Coding and Reimbursement Hotline Support
Our experienced team of Certified Professional Coders understands physician, outpatient and hospital inpatient payment methodologies and provides clear, consistent reimbursement support for manufacturer marketing/sales teams and customers via the establishment of a manufacturer specific Coding and Reimbursement Hotline.
Patient advocacy
With technology evolving at a pace faster than payer coverage it is necessary to provide payer coverage support to product consumers. Our patient advocacy support services make it possible for patients to access the new procedures and technologies being recommended by their physicians.
Clinical Trial Reimbursement
Navigating the pathway to insurance reimbursement and coverage can be difficult for both the sponsor and the study site. Our dedicated team of reimbursement representatives can provide both sponsor and ongoing site support with questions regarding payer coverage during a clinical trial, appropriate claims submission, correct coding and the expected reimbursement.