Our work in reimbursed markets ranges from strategy, to public policy, to discrete technical issues. We navigate these interconnected areas to help medical device manufacturers and others plan for coverage of and payment for new products and services by Medicare and other third-party insurers, as well as position existing products and services being furnished in reimbursed markets. We also model and scenario plan relative to payment reform.

Examples

  • Coverage & Evidence

    National/local coverage, health economic models, clinical trials, field support

  • Coding & Classification

    CPT, HCPCS Level II, ICD-9-CM

  • Payment Systems

    Medicare Part D, MS-DRGs, APCs, RB-RVS, fee schedules

Case Studies

  • Medical device manufacturer

    Obtained Medicare coverage and reimbursement for an osseointegrated implant that replaced the function of the middle ear bones.

  • Diagnostics manufacturer

    Provided the evidence and expert input that amended CMS coverage regulations and manual to expand the scope of colorectal cancer screening to include immunochemical screening tests.

  • Diagnostic test provider

    Collaborated on a successful request to revise a Medicare national coverage determination to cover home-based tests for sleep apnea.

  • Major trade association

    Helped prepare comments that resulted in CMS withdrawing a proposed restriction of the Medicare national coverage determination for routine costs in clinical trials.

  • Long-term care providers

    Prepared draft legislation to remedy flaws in the data used by CMS to revise resource utilization groups.