Reimbursement

In our extremely volatile and ever-changing health care environment, targeted commercialization strategies are vital to the successful launch of new medical technologies. The U.S. healthcare system is not universally accessible – it is a publicly and privately-funded patchwork of fragmented systems and programs. Insured Americans are covered by both public and private health insurance, with the majority covered by private insurance plans through their employers. Government-funded programs, such as Medicaid and Medicare, provide health care coverage to some vulnerable population groups.

Reimbursement Intelligence Assessment

A Reimbursement Intelligence Assessment is a comprehensive analysis of coding, coverage and payment for your technology.  JGS will examine and define the roadmap through the complicated intricacies of the reimbursement process.  Our assessments will provide you with a strategy and a plan for gaining coding, coverage, and payment.

We will include a comprehensive analysis of the current clinical research available to support your technology and provide you with a strategy for developing your clinical story.  JGS will evaluate your regulatory pathway to ensure your path will provide a positive outcome.

Reimbursement Strategy

There is a big misconception that just because you have FDA approval, your product will have coding, coverage and payment. Unfortunately, that is not the case – but JGS is here to help.

Including a Reimbursement Strategy in the first draft of your business plan is vital to the success of your business. We partner with our clients to develop and implement strategic solutions that address barriers to payment for new and existing medical technologies. JGS develops a plan to approach payers, apply for new codes and influence payment through our comprehensive Reimbursement Assessments. This assessment encompasses an analysis of new and existing codes, competing technologies, a payer-mix evaluation, and an economic, and pricing examination.

Strategic Reimbursement Plans

JGS develops a plan to approach payers, apply for new codes and influence payment through a comprehensive Reimbursement Assessment. This assessment encompasses an analysis of competing technologies, new or existing codes, a payer-mix evaluation, and an economic and pricing examination through our coding assessment. JGS combines our experts’ years of experience and specialized market understanding to not only create strategic reimbursement plans but also provide support through strategy execution, from product conception to post-market launch.

JGS combines our experts’ years of experience and specialized market understanding to not only create strategic reimbursement plans but to also provide support through the execution of their customized strategy, from product conception to post-market launch.

Here are some of the many factors we consider when creating your reimbursement plan:

• Customized reimbursement assessment
• Comprehensive competitor analysis
• Clinical literature review and evaluation
• Coding and coverage analysis
• Comprehensive payer policy analysis
• Medicare, Medicaid and commercial payer coverage policy development
• Medical Director interviews
• Physician Advisory Board meetings
• Category B Investigational Device Exemption (IDE) clinical trial coverage and reimbursement
• Investor due diligence evaluations
• Pricing and reimbursement rates
• Actionable blueprints
• Clinical protocol reviews
• Strategic reimbursement planning
• HCPCS/CPT/PLA code applications
• Marketing initiatives
• Investor snapshots
• Payer advocacy
• Reimbursement call center support services
• Insurance verifications
• Claims submission assistance
• Appeals assistance
• Specialized claims submission
• Patient Assistance Programs/Compassionate Care Programs