Strategic reimbursement planning and execution involves the complex and predictive development of comprehensive reimbursement plans that speak to coding, coverage and payment initiatives to help grow your business and successfully commercialize your product.
Our Integrated Approach to Reimbursement Strategy
MCRA takes a big-picture approach when assessing reimbursement and market access strategy, considering the available coverage, coding, and payment pathways. This foundational assessment provides a thoughtful and detailed review of current payer coverage, along with coding and payment policies allowing the RHEMA team to help you identify the most strategic reimbursement pathway to support a strong market position for your technology.
Coverage
MCRA can evaluate the scope of public and private payer coverage policies relevant to your technology and help you gain insight into coverage guidelines, coverage eligibility criteria, and potential barriers to coverage at specific health plans and key payer stakeholders, including:
- Medicare
- Top commercial health plans
- Specialty society treatment guidelines
- Technology assessment organizations
- Utilization management guidelines
Coding
Our certified coding professionals will determine appropriate codes for the client technology and associated procedures and will provide expert guidance on coding gaps and new code acquisition across the following code classification systems.
- Current Procedural Terminology (CPT)
- Healthcare Common Procedure Coding System (HCPCS)
- International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
- International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS)
Payment
Using Medicare payment methodologies, MCRA will identify the key payments applicable to the client technology and similar technologies. We can provide an overview of payments for the facility and physician in the settings of care relevant to the client technology, including the payment options available and requirements for pursing them:
- Hospital inpatient
- Hospital outpatient
- Ambulatory surgery center (ASC)
- Durable medical equipment (DME)
- In Vitro Diagnostics
- Remote patient monitoring
- Physician