Medicare Reimbursement

We develop strategic plans for improving Medicare coding, coverage, and reimbursement by conducting in-depth analyses and leveraging our extensive knowledge of Medicare rules and regulations to provide accurate and reliable recommendations.

We are experts in coding and monitor the quarterly coding updates, annual regulatory changes, and evolving pathways for emerging technologies and therapies. This includes completing applications for new CPT codes, engaging CMS for HCPCS codes, as well as ensuring accurate and compliant coding and documentation practices to reduce denials.

We generate and submit coverage determination requests, ushering clients through the complex process of obtaining Medicare coverage for their products or services while engaging CMS and the MACs throughout the process.

We develop plans to generate the evidence needed to support government payor decision-making in alignment with Medicare requirements.

We provide payment policy analysis that decodes Medicare payment rates, methodologies, and changes that may impact your reimbursement. This includes simulating rate calculations, building evidence to support revised rates, requesting new-technology add-on payments, submitting device-intensive procedure applications, and more.

We analyze claims coding and provide documentation guidance to ensure that your claims are accurate, and that our clients adhere to Medicare's regulatory requirements. To prevent future issues for our clients, we offer training and education on coding and documentation best practices to reduce claims and prior authorization denials. To remedy past issues, we lead engagements with CMS and the MACs to reduce the rate of unpaid claims and resolve any systemic claims processing issues that resulted in unpaid claims.

We enable our clients to capitalize on new opportunities in the space of value-based contracting, including applying to participate in CMS alternative payment models and accountable care organizations, developing proposals to participate in a CMS demonstration project, and outlining alternatives to traditional payment avenues to support increased access and more equitable care.

We drive the implementation of innovative new technologies that can improve the quality and equity of care while also establishing adequate reimbursement rates by Medicare.