1.800.456.4350 info@prgweb.com

Accomplishments

Coverage

Obtained local Medicare and private payer coverage for breakthrough medical devices and diagnostics in the following areas:

  • Cardiovascular implants
  • Electrophysiology
  • Cardiac monitoring
  • Urinary incontinence
  • Ultrasound
  • Orthopedic implants
  • BPH Therapies
  • Tissue substitutes
  • Wound healing therapies
  • Bladder cancer diagnostics
  • Ophthalmology

Secured national Medicare coverage for the following devices that were not covered:

  • Left ventricular assist devices
  • Thoracic electrical bioimpedence
  • Pelvic floor stimulation
  • External counterpulsation

Coding

Assisted in securing CPT code in the following areas:

  • Cardiovascular
  • Orthopedics
  • Urology
  • Gynecology
  • Interventional radiology

Established ICD-9-CM procedure codes for:

  • Cardiac assist devices
  • Therapeutic ultrasound
  • Cardiomyoplasty
  • Cardiac support device

Established and/or revised HCPCS Level II codes for:

  • Phototherapy lamps
  • Infusion pumps
  • Biologic non-human tissue
  • Urologic bulking agents
  • Respiratory products

Payment

Secured hospital outpatient transitional pass-through and new technology designations in the following areas:

  • Interventional radiology
  • Cardiology
  • Urology
  • Pulmonology
  • Electrophysiology
  • Gynecology
  • Ophthalmology

Health Economics

  • Using an economic model for a new diagnostic device, demonstrated an increase in the value of the new technology over standard diagnostics of $2000 to $3000 per diagnosis.
  • Developed economic model for an intravascular device showing that payers would break even if the procedure for the new device were reimbursed at $3000 more than the current technology.
  • Developed a meta-analysis of a tried-and-true technology whose coverage was recently cancelled by a major payer. The analysis showed a substantial benefit of the technology, contrary to the mixed results of the single study that the payer had used to justify its coverage cancellation.

Investor Due Diligence/Business Strategy

  • Provided reimbursement data that has facilitated several mergers and acquisitions.
  • Provided input to venture capital companies to assist with investment decisions.
  • Worked with world leader in medical device design to provide insight for designing devices that will secure maximum reimbursement.

Education and Training

  • Assisted thousands of providers (hospitals and physicians) in understanding coding, coverage and payment for our clients via on-site training, webcasts, reimbursement guidelines and reimbursement support lines.
  • Trained hundreds of sales representatives on reimbursement for their products and procedures