Our Integrated Approach to Reimbursement Coding

Reimbursement coding represents the link between what a provider does for a patient and how that provider is reimbursed by public and private payors for services rendered.

MCRA’s team of coding, coverage, and reimbursement experts can help your company understand how the current coding systems impact your technology or procedure, what challenges providers may face, and opportunities to better define your technology or procedure in the future.

Understanding Current Codes and Their Impact:

Coding Analysis & Landscape Assessment

  • Examine the Current Reimbursement Coding Pathways
  • Identify Reimbursement Challenges or Opportunities for the Product or Procedure
  • Explain How Current Reimbursement Codes Will Impact Product or Procedure Adoption

Strategizing for the Future:

Strategic Reimbursement Coding Plans

  • Incorporate Findings from the Coding Analysis/Assessment
  • Identify Options for Addressing Coding Deficiencies
  • Develop a Comprehensive Strategy to Secure Appropriate Coding Options

Communicating to Providers:

Billing and Coding Guides

  • Describe Reimbursement Coding Pathways for the Technology and Procedure
  • Validate Options Using Industry Resources
  • Reimbursement Coding Can Be Displayed on Products or Company Websites

Securing Appropriate Coding:

New Procedure Reimbursement Code Development

  • Identify the Reimbursement Code Description
  • Identify Supporting Clinical Literature
  • Work with Specialty Societies to Gain Consensus
  • Identify Potential Stakeholder Questions or Objections
  • Develop and Submit New Reimbursement Code Request

Current Procedure Reimbursement Code Revision

  • Identify the Change Needed to Include the Procedure
  • Work with Specialty Societies to Gain Consensus
  • Identify Potential Stakeholder Questions or Objections
  • Develop and Submit the Revised Reimbursement Code Request

Technology and Add-On Payment

  • Secure Product-Specific Coding (HCPCS Codes)
  • Develop and Submit Medicare New Technology Add-On Requests
  • Perform Analyses to Determine Appropriate APC Assignment

 

Our Integrated Approach to Pre-Authorization

Commercial health plans are increasingly denying coverage for new technologies and procedures. Even a small omission of clinical information can lead to an unnecessary denial.

MCRA’s Coverage Access Management team can assist providers and patients with the pre-authorization submission and pre-authorization appeals process for commercial health insurance plans.

A coverage access team member will work with physician practices, facilities, patients, family members, and insurance companies to:

  • Perform insurance verifications
  • Facilitate pre-authorization and pre-authorization appeal requests
  • Manage the status of pre-authorization and pre-authorization appeal requests
  • Provide consistent, comprehensive payor education regarding the procedure

MCRA's coverage access management team assists providers and patients by:

  • Providing a repository of published clinical data describing the procedure and clinical study outcomes
  • Understanding and communicating the information that health plan reviewers are requestions
  • Educating the provider and patient about prior authorization appeal rights and processes
  • Preserving prior authorization appeal options by monitoring individual health plan deadlines and requirements