Reimbursement Strategy

In the continually evolving health care landscape, reimbursement is a fluid process requiring business plan integration for both new and existing technologies. We know that the success of your product launch or market adoption often depends on how well your company has integrated reimbursement into its planning process. Argenta collaborates with you to tailor a proactive reimbursement strategy for each specific technology.

To accomplish this, we typically begin with an analysis of coding, coverage, and payment to identify the hurdles and opportunities that will impact the launch and market adoption of your technology. These key factors are summarized below:

Coding

Appropriate coding (CPT, ICD, HCPCS, etc.) is an integral component of any successful product launch. If codes for a technology currently exist, we review their impact and the way the codes relate to coverage and payment in each site of service. If no codes exist, we work to determine how the technology will be coded, both in the short- and long-term, in all relevant sites of service and by all relevant payers. We also review the process of and timing for obtaining a code(s) for the technology.

Coverage
Gaining coverage or addressing issues for a new or existing technology in a complex healthcare system requires understanding the technology’s impact on patients, providers, and payers. For example, which patients and providers are likely to utilize the technology? What types of health plans are likely to be impacted (e.g., Medicare, commercial payers, etc.), and how are they likely to view the technology? What potential coverage challenges are likely in each payer market? What type of data will be required to support a positive coverage policy? Will the data from the FDA approval/clearance process be adequate for coverage? We will help you answer all of these questions and, as importantly, integrate the findings into the overall launch strategy.

Payment

When current payment schedules for a technology are already established, we review reimbursement for all relevant sites of services. If, however, current payment is inadequate, we seek ways to improve payment via appropriate coding changes and/or directly with payers.