Payer Reimbursement Landscape
Our work to conduct a detailed Medicare, Medicaid and commercial coverage and payment analysis to assist a client with launch planning.
To assist a client with launch planning, ADVI analyzed Medicare national policy, select Medicaid states’ policies, and select national, regional and local policies; examined local Medicare MAC policies or DMAC policies (key for DME, Dx, oral anticancer and supportive care products); and conducted payer interviews to gauge likely hurdles and anticipate management.
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Real analysis from people who’ve been there
Remote Therapeutic Monitoring
ADVI worked with the client and the AMA’s Digital Medicine Payment Advisory Committee to develop new CPT codes for remote therapeutic monitoring.
Cardiovascular Technologies
Reviewed primary clinical study literature and, based on published Medicare precedents and processes, produced mock National Coverage Determinations on several invasive cardiovascular technologies, applying typical CMS standards and formats.
Lumbar Spine Stenosis Device
ADVI worked with the client and CMS to reverse a negative draft NCD and obtained a final NCD with CED that required a randomized clinical study.
Non-Opioid Device Pain Relief Product
Assessed the positioning of a client's non-opioid pain relief device versus competitive products, including drugs and other devices used to treat pain.
AI Device for Osteoporosis Assessment
ADVI helped a client obtain a new Category I CPT code for the trabecular bone score AI software device.
Osseochondral Knee Implant
ADVI analyzed the reimbursement environment for a novel osseochondral implant under development to determine whether existing codes and payment would be sufficient for the new device.
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