payer & cms relations
FINDING AN ALTERNATIVE ROUTE TO REIMBURSEMENT
Situation
A medical device venture offers a prosthetic/orthotic that benefits patients in both hospital and home health care settings. However, no billing mechanisms were in place to support the product’s use in either environment.
Our Role
Working in close collaboration with the client and insurance organizations, we identified a billing pathway for the device.
Outcome
To drive this agenda forward successfully, we conduct detailed research and interpretation of existing billing and payment guidelines. In addition, we represented the client’s interests throughout rigorous fact-finding and intensive ongoing dialogue with Medicare, hospitals and home health agencies.
Impact
Ultimately, we helped open the door to more widespread use of an item for which healthcare organizations previously were unable to bill.