Health Economics and Reimbursement: HER™ Services

• Technology feasibility analyses
• Technology landscape analyses
• READ™ Report - Reimbursement Analysis and Discussion
• Reimbursement assessment and strategy development
• Coverage Acceleration Program (CAP) | policy development
• Insurer interactions (formal and informal)
• CPT®, HCPCS, and ICD-10-CM code development and applications
• Structured qualitative surveys of managed care medical directors, physicians, health care facility executives, and purchasing decision-makers
• Technology assessments
• Payment analyses
• Literature gap analyses
• Device dossiers
• Billing guides and sales tools
• Reimbursement training
• Outcomes studies to support economic and quality-of-life analyses
• Medicare proposed and final rules analyses

• Procedure and diagnosis data through TrueData® reports (more below)
• Sales positioning
• Clinical trial focus opportunities
• Payment level analyses
• Longitudinal cohort studies
• Cost-effectiveness analyses
• Pricing analyses
• Payer mix and setting of care analyses

MTP offers customized TrueData® reports that combine statistical data from multiple years and sources into one comprehensive package.

• Provides payment and utilization information for various care settings (e.g., physician office, inpatient, outpatient, and emergency departments)
• Contains trend data over three or more years
• Utilizes procedure or diagnosis codes to focus on specific procedures or diagnoses

MTP’s advisory panels consist of medical directors from commercial health plans and help validate, test, or generate ideas around a product to improve its trial and acceptance.  MTP has three options to help you better understand what insurers require to cover your technology.

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• Online Evaluation:  Online evaluations are a great way to get a bird’s eye view of what insurers want and need.
• Phone Survey:  Structured phone surveys provide opportunities for probing and discussion that can unveil additional detail that may not be captured with an online evaluation.
• Focus Panel:  A gathering of medical directors in the same room allows for real-time, lively discussion of your technology and how insurers view its pros and cons based on the presented evidence​

 Coding, coverage, and payment guidelines do not remain static.  These practices and policies change and evolve due to various factors and influences, such as cost constraints, new technological developments and enhancements, and political stimulus, and can dramatically change the sales environment for products and services.  The challenge is substantial for medical device manufacturers not only to remain current, informed, and armed with the latest reimbursement intelligence, but to understand how to strategically interpret and act on coverage policy intelligence. 

• Monitors coding, coverage, and payment policies relevant to your technology
• Provides real-time online access to users
• Conveys communications of an alert-type nature as necessary
• Incorporates Medicare and commercial/private payer policies

MTP’s RRC is a one-stop location for hospitals, ASCs, physicians, and patients to secure the latest information about coding, coverage, payment, prior authorization, claims submission, and appeals for a technology.  Regular reporting contains summarized information on cases, including any identified trending analyses and a dashboard summary of significant and relevant parameters that is useful for executive management.  MTP is able to integrate and report on RRC activities to meet diverse business goals (e.g., sales, marketing, reimbursement, executive management).

• Resource Center:  Addresses questions regarding coding, billing, and payment questions
• Prior Authorization Program:  Submits prior authorization requests to insurers and coordinates appeals
• Appeal Support:  Assists providers with appealing denied or underpaid claims and/or submits appeals directly to insurers 
• Claims Tracking:  Secures Remittance Advice (RA) notices to generate an analysis of insurer claims status and outcomes. 
• TrueValue™ Patient Registry:  Prospective observational data collection focused on the real-world evidence outside of the formal clinical study setting that is intended to capture the reality of the patient’s experience 

 The reality for a medical device company is that it will need to raise money at least once if not more than once.  That means both the company CEO/Board and (potential) investors must understand the company's reimbursement plan, including budget, personnel, strategy, and tactics.

MTP communicates effectively with reimbursement managers, senior executives, and investors with the appropriate language and clarity.  Our experience and expertise can make a significant contribution to a medical company at all stages of the company's development and product life cycle.