Medtech Coverage, Coding and Reimbursement 101 and 201 Workshops

Overview

Learn the basic principles of how medical technologies are covered and paid by insurers, the challenges medtech companies face and strategies they can use to achieve positive outcomes for coverage and appropriate reimbursement during our online Medtech Coverage, Coding and Reimbursement 101 and 201 Workshops. Registration is now open.

Workshop 101

The 101 Workshop will discuss the “three-legged stool” of payment—coding, coverage, and reimbursement—as well as reviewing market access opportunities for novel technologies through both existing Medicare payment pathways and proposals to streamline Medicare policies in the future.

Workshop 201

The 201 Workshop will focus on special topics in reimbursement, including: how diagnostic tests are paid by Medicare; challenges in coverage pathways for digital technologies; and demonstrating value of medical technologies and data and evidence to be covered by public and private payers.

Registration Pricing

AdvaMed Member Companies: $350.00

AdvaMed Accel Member Companies: $250.00

Non-Members: $650.00

Government/Academic: $255.00

To see a full list of AdvaMed Member Companies, click here. 

If three or more register from your company please use this 10% off discount code: GROUP10    

If you are signing up for both 101 and 201 please use this 10% off discount code: BUNDLE10 *Please note all discounts must be applied at the time of purchase.

Medtech Coverage, Coding and Reimbursement 101

Tuesday, April 18 

Introduction to Medicare

Richard Price, Senior Vice President, Payment & Health Care Delivery Policy & Head of Research, AdvaMed 

Kirsten Tullia, Vice President & Interim Head of Payment & Health Care Delivery Policy, AdvaMed

Tara Burke, Vice President, Payment & Health Care Delivery Policy  

• Basic introduction to the Medicare Program  
• Overview of Medicare’s benefit structure and how the program is funded  
• Learn how benefits are delivered to Medicare beneficiaries  

Introduction to Reimbursement for Medical Technology 

Thomas A. Gustafson, Ph.D., Senior Policy Advisor, Arnold & Porter

• What are the key elements determining reimbursement for medical technology (devices, diagnostics, and combination products)? 

• Overview of coverage, coding, & payment — Medicare and other payers 
• Who decides what and when? 
• Roles of FDA and CMS 
• What should be in a company’s reimbursement strategy? 

Introduction to Coding for Medical Technology  

Tara Burke, Vice President, Payment & Health Care Delivery Policy  

• Introduction to coding languages (CPT, ICD-10 PCS, HCPCS) 
• How codes are used in different settings 
• Understand the application process and timelines for key code sets  

Break

Intro to Medicare Payment Systems 

Deborah Godes, Vice President, McDermott+ Consulting

• Understand how Medicare pays for services in the hospital inpatient and outpatient settings 
• Understand the basic methodology used by CMS to pay for physician services 
• Learn how Medtech is incorporated into these payment methodologies 

Wednesday, April 19 

Welcome Remarks 

Complexities of CMS Coverage

Marjorie Kanof, Principal, and Marc Hartstein, Principal, Health Policy Alternative

• Overview of CMS’ NCD process
• Review of current CED process and recent recommendations from AHRQ
• Other restrictions/requirements of CMS coverage (e.g., screening tests)

Coverage Opportunities for Novel Technologies 

Mark Domyahn, MBA, Partner, JD Lymon Group

• Provide an overview of Medicare’s incremental hospital payment for new technologies, including the New Technology Add-On Payment (NTAP) and Transitional Pass-Through (TPT), and Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES) 

Alternative Payment Models 

Amy Bassano, Managing Director, Health Management Associates

• An overview of the authorities granted to CMS in testing new payment models  
• A brief review of how CMS has used this authority in the past, including examples of previous and current models  
• A forecast of how CMS may engage in this space moving forward based on the Innovation Center Strategy Refresh, and how Medtech innovations can support this vision  

Break

The World Outside of CMS

Sarah A. Davis, MPH, Sr. Director, Global Operations, Market Access, and Field Health Economics & Reimbursement, Abbott Medical Devices 

• Identify other payers (beyond CMS, the single largest payer) that pay for Medtech (Medicaid, Workers’ Comp, etc.)  
• Understand these payers’ objectives and philosophies, if different from CMS  
• Develop strategic and tactical approaches for interacting with other payers  

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Medtech Coverage, Coding and Reimbursement 201 

Tuesday, April 25 

Day 1 

Welcome Remarks

Payment for Diagnostic Laboratory Tests 

Charles Mathews, Managing Director, ClearView Healthcare Partners

• How tests are paid under several payment systems  
• Update on Medicare’s move to “market-based” rates for tests on the Clinical Lab Fee Schedule    
• Advanced Diagnostic Laboratory Tests – special rules 
• Changes in response to the Public Health Emergency 

Emerging Issues in Coverage of Digital Health Technologies in Medicare

Liesl Oldstone, Vice President, Health Economics and Market Access, AppliedVR

• Coverage and Payment Landscape in Medicare for DHTs    
• Opportunities in Medicare Advantage and Alternative Payment Models    
• Case Studies – Company Perspectives  
• Looking Forward: Recognizing the value of DHTs  

Patient Preference Data

Barry Liden, USC Schaeffer

Harry Kotlarz, MBA Assistant Vice President, Health Economics and Patient Value, Medical Device Innovation Consortium (MDIC)

• Understanding patient preference information and its role in promoting patient-centric health care that results in improved outcomes, better patient experiences, and reduced costs 
• Understanding the role of patient preference information in health technology assessments and payer decision-making  

Trends in Commercial Insurance Coverage  

• Overview of Commercial Insurance Landscape (e.g., employee-based, Medicare Advantage, non-group individual coverage)      
• Compare and Contrast of Major Commercial Insurance Plans  
• Considerations for Medtech Companies  
• Emerging Trends in Commercial Insurance Coverage   

Wednesday, April 26 

Day 2 

Welcome Remarks 

Healthcare on the Hill

Brett Baker, Partner, The Nickles Group

• Overview of key players and committees
• Understand the current legislative landscape for Medicare policy
• Identify key opportunities and challenges for advancing healthcare policies on the hill

Medtech Value Framework & Application 

Glenn Snyder, Medical Technology Segment Leader, Deloitte  

Sujay Viswanath, Managing Director – MedTech
Commercial Strategy, Deloitte Consulting LLP

• How to ask the right questions that are fundamental to demonstrating value 
• How to use AdvaMed’s Value Framework to assess value and likely evidence requirements of a new technology 
• Overview of recent updates to AdvaMed’s Value Framework 
• Integrating the framework into your reimbursement strategy – practical examples and steps 
• What are some pitfalls to avoid when using the value framework?   

Strategic Positioning: Evaluating Where You Are

Leslie Wise, Principal Consultant, Evidence Matters 

• Evaluating the potential payer landscape for your technology and planning the best route to market 
• How can reimbursement considerations affect product design, the choice of targeted patient populations and indications, and regulatory, clinical, and sales & marketing strategies 

Communicating Evidence & Value: Making the Case for Coverage

Michael D. Miller, MD, Health Care & Life Sciences Consultant and Advisor

• Developing data and evidence, which then can be translated into effectiveness and value propositions for payers and stakeholders 
• How Real-World Evidence (RWE) and Digital Health are changing the Medtech landscape for evidence 
• What will be different after the COVID pandemic, i.e., when SARS-CoV-2 is endemic