Reimbursement Strategies Consulting Services

Achieving a focused reimbursement strategy is critical for bringing a medical device or medical technology to market successfully. Our goal is to help medical technology companies navigate the reimbursement process. Our core services include:

Reimbursement Strategy

The Patient Protection and Affordable Care Act of 2010 has changed the dynamics of all healthcare delivery and financing. Reimbursement Strategies, LLC, understands government and private payer coverage and payment policies within the context of the current health economics environment. We design strategies around specific objectives targeted toward any reimbursement barriers that would otherwise limit broad market adoption of emerging medical technology

Reimbursement Assessment

A reimbursement assessment is a research-based report that identifies possible barriers to appropriate coding, coverage and payment for a technology. In conducting assessments, Reimbursement Strategies, LLC, identifies any differences in clinical indications for coverage based on place of service (inpatient vs. outpatient hospital, clinic, or home care setting), payer mix and comparable technologies. The assessment forms the basis for creating a reimbursement strategy.

Reimbursement Due Diligence

Small and mid-size medtech and biotech companies with novel technology are frequent, attractive targets for acquisition.  Reimbursement Strategies, LLC, works with venture capital companies and corporate investors to do reimbursement due diligence to assess market risk prior to investment.  In this context, a due diligence report is similar to a Reimbursement assessment.

Health Economics Analysis

The health economic environment is becoming increasingly challenging. Payers often demand evidence of cost effectiveness, not just clinical effectiveness, before accepting new technology and services. Reimbursement Strategies, LLC, provides varying levels of analyses to demonstrate cost effectiveness and to accelerate favorable medical policy coverage. The level of sophistication and detail can be scaled to different purposes and budgets. The gold standard continues to be analyses that are worthy of publishing in major medical journals.       

Payer Advocacy and Negotiations

Existing medical policies are often too restrictive to account for new diagnostic or therapeutic interventions. Reimbursement Strategies, LLC, is extensively networked with government and private payers to advocate for favorable coverage policies and secure appropriate payment in support of new medical technology. Advocacy may take the form of Medicare coverage redeterminations, local coverage determination public hearings, private payer medical policy appeals or face-to-face negotiations.   

Code Analysis and Applications

Product and service coding forms the basis from which coverage and payment decisions are made—it is extremely important. There are tens of thousands of service codes and modifiers which describe physician, hospital and DME products and services. Securing the most appropriate code assignment is critical for market success and payer audit protection.  Reimbursement Strategies, LLC, has extensive experience working with the AMA CPT Editorial Panel, medical societies, the CMS HCPCS Workgroup and the Pricing, Data Analysis and Coding (PDAC) contractor. The reimbursement process starts with coding, and it must be done right.  We use certified professional coders for all critical coding decisions and new code applications.

Clinical Dossier Development

A dossier is a marketing tool targeted to the specific interests and concerns of payers and is frequently required to secure government and private payer coverage. Payers have different motivations as compared to hospitals, physicians or patients. Reimbursement Strategies, LLC, understands this and creates clinical dossiers to address their concerns related to key attributes about the medical product or service, clinical indications for use, mechanism of operation, supporting technology, literature reviews, cost effectiveness, and prevalence of the disease condition for which the product is targeted.