Medical Device Coverage: Do Private Payers Follow Medicare’s Lead?

Perspectives on Medical Reimbursement By JR Associates When making decisions about medical device coverage, do private insurers take their cues from Medicare (CMS)? Not necessarily, according to a recent study published in the peer-review journal, Health Affairs. According to the research abstract, an analysis of CMS national coverage decisions (NCDs) revealed that: ~50% were equivalent to corresponding private payer policies ~25% were…

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Proposed Changes In MPFS IDE Clinical Trial Coverage Rule: Comments to CMS

Perspectives on Medicare Policies By JR Associates SUBJECT: Medicare Physician Fee Schedule Rule: Proposed Changes for the Process for Covering Items and Services in an Investigational Device Exemption (IDE), Centers for Medicare and Medicaid Services (CMS) 78 Fed. Reg. 43282, 43342-47, 43523-25 (July 19, 2013) OVERVIEW: JR Associates is concerned about CMS’ proposed changes to…

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Amyvid & Alzheimers Lesson: FDA Approval Is Not A Coverage Guarantee

Perspectives on Medical Reimbursement By JR Associates The path to advancements in disease detection and treatment is notoriously complex, circuitous and costly. However, even after FDA approval, there are no guarantees of reimbursement through CMS coverage. This is an essential lesson in the case of Eli Lilly’s Amyvid PET scan imaging agent, which is used…

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Medical Device Innovation: Is a Code Necessary for Commercial Adoption?

Perspectives on Medical Reimbursement By JR Associates For some medical devices, more than one reimbursement pathway may be viable. And, as JR Associates recently explained to Medical Device Daily, that could be the case for the Dune MarginProbe – a system that delivers real-time breast cancer detection in the operating room, by helping surgeons assess…

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