New medical devices hold the promise of better health and outcomes. Some patients, however, may not have access to medical breakthroughs if coverage is denied by Medicare and private payers or if payment is inadequate. A thorough assessment of the reimbursement environment for a new technology provides the foundation upon which market success will be built. Princeton Reimbursement Group can help you define and implement reimbursement strategies early in the product development process.
Several key issues must be addressed during the reimbursement planning process, such as:
- Who will eventually pay for the product, e.g., will it be patients, physicians, hospitals, Medicare, private insurance, workers compensation, etc.?
- What are the current coverage policies of Medicare, private insurance, etc., for the procedures related to the product?
- If covered, is reimbursement adequate to justify widespread use of the product? If not, how can reimbursement be increased?
- Will all of the indications for the product be covered?
- Can the product pass utilization review?
- Are there existing CPT and ICD-9-CM codes that describe the procedure? If not, how can they be established?
- Does the product have the potential to reduce health care spending?
- What federal health care policy changes can be anticipated throughout the product development process and how will they impact eventual product release?
- How will outcomes evaluation and development of practice guidelines impact use of new products?