EBG Advisors assisted a medical device developer and DME supplier regarding Medicare claims related to its new-to-market prosthetic which did not have an assigned Medicare benefit category, coverage policy decision, or payment determination.

Assisted by EBG Advisors, the client submitted its first claim to a Durable Medical Equipment Medicare Administrative Contractor. Following this submission, EBG Advisors conducted a technical review of the documentation provided to inform the client of what Medicare coverage and payment rules might apply. Our advisors also provided guidance and support on how to bring this first claim into technical compliance and worked with the client’s staff to develop defensible documentation to establish the medical necessity and appropriateness of the device.

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