Assist in Obtaining Coverage from Medicare and Other Payers
- Developed Local Coverage Determinations (LCDs) while a CMD
- Understands the National Coverage Determination (NCD) and LCD process and assists clients in navigating those processes
- Advises clients on whether to request an NCD or LCD
- Advises on how to draft NCD and LCD requests and reconsiderations
- Drafts coverage request
- Drafts comment letters to proposed NCDs and LCDs
- Prepares clients for meetings with CMS and MACs on coverage issues
- Has obtained or revised coverage policies on a variety of issues for many clients including medical specialty societies, IDTFs, clinical labs, and medical device manufacturers
Medicare & Commercial Payers Assist in obtaining appropriate reimbursement
- On behalf of medical specialty society clients, participates in the RUC survey process and drafts the rationale for coding recommendations
- Prepares clients to participate at the RUC
- Attends RUC subcommittee meetings
- Arranges clint meetings with CMS before preparation of the yearly rulemaking cycle to make recommendations for the proposed rules
- Draft comment letters for clients on Medicare payment proposals
- Prepares client for meetings with CMS on reimbursement issues
- Attends CMS meeting with clients
- Interacts with CMS staff on an ongoing basis
Medical Devices
- Assists medical device manufacturers in obtaining appropriate payment under the hospital inpatient and outpatient prospective payment systems
- Assists in obtaining appropriate DRG and APC assignments
- Assists clients in obtaining transitional pass through and new technology add-on payments for the outpatient and inpatient hospital payments systems, respectively
- Works with clients to obtain appropriate reimbursement under the medical physician fee schedule
- Drafts comment letters and meets with CMS on physician reimbursement issues
- Prepares clients for meetings with CMS
Diagnostic Tests
Assists clients in obtaining Medicare national coverage or local coverage determinations, including through MolDx
Assists in preparing dossiers to submit in support of coverage
Assists in preparing for, and participates in, meetings with CMS and MACs
Assists clients in preparing for and participating in the annual CMS public lab payment meeting
Assists in submitting comments to, and meeting with, CMS in response to preliminary payment decisions
Assists in requesting reconsideration of payment decisions
Assists in negotiating payment with MACs when there is no national payment
Assists in connection with PAMA reporting requirements
