Coverage, Codes & Payment for Durable Medical Equipment


Reimbursement Case Brief

A leading medical device manufacturer discovered that billing problems were hindering adoption of a durable medical equipment item used for end-of-life care among pulmonary cancer patients.

Our Role
Uncertain about the root cause of these reimbursement challenges, the manufacturer turned to us for perspective and guidance.

Our resourceful consultants probed deeply across-the-board to uncover the underlying issues leading to billing failures. While moving through this fact-finding process, we connected the dots between symptoms, causes and appropriate remedies. We also confirmed with Medicare, Medicaid and healthcare suppliers that these remedies were valid solutions.

The various billing issues were not immediately solved. However, we did resolve the confusion. Our extensive interactions with healthcare suppliers and payers helped us to paint a complete, realistic picture of the reimbursement landscape for the device. Along the way, we even discovered that Medicaid offered a viable billing pathway – an avenue that the manufacturer hadn’t previously considered.

Bottom line: we established stronger communication between the device company, product distributors, healthcare providers and insurers. As a result, more patients now receive access to better-quality healthcare.

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