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Expertise

Navigating the maze of reimbursement and health economics can be daunting. I offer knowledge, experience and many years of success to help you achieve your goals.
Strategic Reimbursement

  • Landscape assessments

  • Strategy development, including potential impact on Pricing, Regulatory and Clinical Strategies

Payer Coverage Analysis

 

  • Medicare

  • Private

  • Other payers including Workers’ Compensation, Medicaid, etc.

Coding Assessment and Strategy 

 

  • ICD-10, CPT, HCPCS Level II

  • Application development

  • Physician society engagement

Strategic Payment Assessments

 

  • Hospital inpatient (MS-DRGs)

    • New Technology Add-On Payment

    • MS-DRG reassignment

  • Hospital outpatient (APC)

    • APC reassignment / creation

    • Transitional APC Pass-Through Status

    • New Technology APC

  • Ambulatory Surgery Centers

  • Physician payment

  • Other facility payments, including LTCH, HHA, SNF and CAH

 

 

Due Diligence

 

  • Reimbursement assessment for new and existing products

Coverage

  • Medicare

    • National Coverage Determinations (NCDs)

    • Local Coverage Determinations (LCDs)

    • Engagement with national CMS and local Medicare Administrative

    • Contractors

    • Private and other payers – policy review and KOL engagement

 

Clinical Trial Assessment

  • Trial design considerations to support reimbursement at commercialization

     

 

Health Economics & Reimbursement

  • External – customer visits, webinars, etc.

  • Internal – Sales, Senior Leadership, Marketing, Regulatory, Clinicial

 

Clinical Trial Reimbursement

  • Engagement with CMS national process and approvals

  • Engagement with Medicare Administrative Contractors on local requirements

  • Training materials for sites

    • Coding guidance, including proper billing for clinical trials

 

 

Health Policy

Tool Development

  • Coding and reimbursement guides

  • Economic selling tools – spreadsheets, IPad apps

  • Customer specific payment tools 

    Payer dossiers

 

  • Monitor and interrupt policy shifts in Medicare and other government payers

    - Annual rule updates – IPPS, OPPS, ASC, MFS, etc.

    - Periodic rule changes – CJR, ACO, etc.

 

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