Resources

Presentations Related to Reimbursement

Emerson Consultants Overview: Download PDF (120KB)

Snap shot view of Emerson Consultants and expertise in the areas of reimbursement, regulatory, clinical, and marketing.

Fundamentals of Reimbursement: Download PDF (170KB)

Overview of the reimbursement process with a specific look at the current reimbursement environment for nucleus arthroplasty technology and other new spinal devices.

Integrating Reimbursement into Sales Cycle: Download PDF (170KB)

How and why to use field reimbursement specialists to integrate the economic value proposition into the sales cycle.

Navigating the CMS Pass-Through Maze: Download PDF (170KB)

Overview of the processes CMS uses to determine eligibility for pass-through-payment and how to determine if a technology is eligible.

Reimbursement and Clinical Trial Data: Download PDF (200KB)

Explanation of how and why to structure a clinical trial to collect data that satisfies both regulatory requirements and the requirement of payors.

Reimbursement Strategy: Download PPT (2MB)

Comprehensive presentation on why reimbursement matters and the key drivers of reimbursement strategy: coverage, coding, and payment.

100 Initial Priority Topics for Comparative Effectiveness Research:
Download PDF (41 KB)

A list of the top priorities for comparative effectiveness research prepared by the Institute of Medicine and contained in the report Initial National Priorities for Comparative Effectiveness Research. Topics are listed by quartile according to priority.

Adverse Event Reporting for Medical Devices: Download PDF (830 KB)

Department of Health and Human Services report issued in October 2009 that documents the number of adverse events reported from 2003 to 2007 and assesses manufacturers’ compliance with reporting requirements and FDA use of adverse event data to address safety concerns. Also makes recommendations on how to improve FDA use of adverse event reports to identify and address safety concerns.

Investigator Responsibilities - Protecting the Rights, Safety, and Welfare of Study Subjects: Download PDF (164 KB)

FDA guidance document issued in October 2009 providing an overview of investigator responsibilities to supervise the conduct of drug and device trials to protect the rights, safety, and welfare of participants.

Articles Written by Emerson Consultants

Call to Action: Local Non-Coverage Draft Policy for Artificial Discs: Read Article

Author: Kelli Hallas

Article about a proposed Medicare policy to deny coverage for artificial discs and call to action to submit comments urging further consideration.

Differentiating the Needs of Key Stakeholders to Obtain Reimbursement for New Technologies: Read Article

Authors: Kelli Hallas and Barb Peterson

Explanation of differing data requirements for regulatory approval and reimbursement coverage. Also outlines the key drivers payers use to evaluate a new technology to determine coverage.

Other Resources

Current Reimbursement Environment for Continuous Glucose Monitoring: Download PDF (400 KB)

Author: Patty Curoe Telgener

Description of trends in the current reimbursement environment for continuous glucose monitoring and recommendations on coding and coverage.

Websites to obtain further information

AdvaMed: http://www.advamed.org

Agency for Healthcare Research and Quality: http://www.ahrq.gov

American Hospital Association (AHA): http://www.aha.org

American Medical Association (AMA): http://www.ama-assn.org

American Medical Association ICD-9-CM, CPT, and HCPCS publications: http://www.amapress.org

American Public Health Association/Legislative Affairs Page: http://www.apha.org/advocacy/activities/legislativeupdate/

Blue Cross Blue Shield Association: http://www.bcbsa.com

Center for Devices and Radiological Health (CDRH): http://www.fda.gov/cdrh/index.html

Centers for Disease Control (CDC): http://www.cdc.gov

Centers for Medicare and Medicaid Services: http://www.cms.hhs.gov

CMS Contact Information Directory: http://www.cms.hhs.gov/apps/contacts

Electronic Code of Federal Regulations (eCFR): http://ecfr.gpoaccess.gov

Federated Ambulatory Surgery Association: http://www.fasa.org

Health and Human Services Office of Inspector General: http://www.oig.hhs.gov

Health Insurance Portability and Accountability (HIPAA): http://www.cms.hhs.gov/HIPAAGenInfo

Medicaid Program - General Information: http://www.cms.hhs.gov/MedicaidGenInfo/

Medicaid Program - Contact Information: http://www.cms.hhs.gov/apps/firststep/content/medicaid-contact.html

Medicare Coverage Database: http://www.cms.hhs.gov/mcd/search.asp

Medicare Posting of Potential NTD Topics (Comment period closed 9/28/2008): http://www.cms.hhs.gov/mcd/ncpc_view_document.asp?id=19

National Correct Coding Initiatives Edits: http://www.cms.hhs.gov/NationalCorrectCodInitEd

Physician Fee Schedule: http://www.cms.hhs.gov/PhysicianFeeSched

Physician Fee Schedule Look-Up Tool: http://www.cms.hhs.gov/PFSlookup/

United States Congress: http://www.congress.org

U.S. Food and Drug Administration (FDA): http://www.fda.gov

World Health Organization (WHO): http://www.who.int

The materials and information provided within these documents are for educational and informational purposes only. There is no guarantee from the author that this information is current, or that government agencies and commercial entities fully agree and comply with this information. It is the responsibility of the healthcare provider or industry stakeholder to validate procedural-specific coverage, coding, and payment policies for any procedure, service, or medical technology. Similarly, all CPT®, HCPCS, and ICD-9 codes are supplied for information purposes only and represent no statement, promise, or guarantee by the author that the codes are appropriate or that payment will be made. CPT® is a registered trademark of the American Medical Association. Copyright 2009, all rights reserved.

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