Reimbursement Consulting: Implementation.
Applying for reimbursement codes, coverage policies and favorable payment rates.
Depending upon the existence, or the lack of, applicable reimbursement mechanisms (as identified in Activity 1 - Reimbursement Landscape), Deliverables in this Activity 3 include:
(Back to main Reimbursement Process page).
Deliverables
In case existing reimbursement mechanisms may be used for the new product:
a.
Billing guide:
Develop a set of instructions guiding physicians on how to receive reimbursement following the use of the new device / drug.
b.
Dossier:
Compile the Value Story, Economic Model, any published evidence and the billing guide to a dossier that would be used to convince healthcare providers to purchase the new device / drug under existing reimbursement mechanisms.
In case new reimbursement mechanisms will have to be developed:
a.
User base:
Help establish a sufficient, documented, user-base of patients, physicians and centers using the new device / drug.
b.
Support of local medical community:
Verify support of relevant medical societies and local key opinion leaders.
c.
Authorizations and denial appeals:
Train physicians and develop collateral to support routine requests for case-by-case coverage and denial appeals, if necessary.
d.
Pilot projects:
Facilitate pilot projects with individual payors.
Flat fees, concrete timelines, and support through your entire reimbursement process
