Our clients hire us because we have the experience, strategic insight, and judgment to answer critical reimbursement questions efficiently.

  • Reimbursement Assessments:

    When venture firms or investors evaluate a new technology, they want to know if the product is reimbursable, potential pricing that will be acceptable to payers, and the cost of achieving optimal reimbursement. To prepare a reimbursement assessment, we determine the most important payers for a particular product, evaluate payment for comparable products, survey private and public health plan medical directors and/or pharmacy managers about their possible policy decisions, gather published data on current fee schedules and other payer reimbursement, and evaluate potential pricing. Our report summarizes reimbursement issues facing the product and advises on how to achieve successful coverage, coding, and reimbursement.

  • Reimbursement Input into Corporate Strategic Planning:

    Companies frequently request reimbursement input to their corporate strategic planning activities. Typically, we analyze how US health care reform, Medicare and Medicaid policy changes, and private reimbursement trends will shape pricing and market size for specific product segments. Based on the trends, we may suggest areas for future product R&D.

  • Product Reimbursement Plans:

    To launch a new product today, manufacturers must take responsibility for securing public and private reimbursement. This involves applying to Medicare, managed care plans, and Medicaid for specific coverage policies, codes, and payment.We help companies develop a strategic and practical reimbursement plan that will ensure rapid payer adoption when the product is launched. We determine which third-party payers cover the targeted patients, determine potential payer coverage policies, estimate payer payments for the product, outline the steps in applying for new codes, and provide a detailed timeline for obtaining successful insurance policies.

  • Reimbursement Launch, Monitoring and Troubleshooting:

    Rapid payer adoption and favorable payment is critical to marketing success. We work with manufacturers to introduce medical products to insurance companies. We prepare the economic and clinical dossier of information that evidence-based payers require before making coverage decisions. We also contact professional societies and technology evaluation groups to ensure appropriate recommendations and guideline development. We work with payers on coverage and reimbursement policies and monitor payment of claims. We also work with company staff and customer billing personnel to resolve problem claims. We can provide a team composed of a 1-800 hotline service and a payer lobbyist to aid in this effort.