Events

MedTech Coverage, Coding and Reimbursement 101 and 201 Workshops

101 Workshop: March 22-23, 2022
201 Workshop: April 26-27, 2022

Register Now

Explore and discuss the Medicare program’s rules and processes for coverage and payment, new payment models, private payer challenges and more.

MedTech Coverage, Coding and Reimbursement 101 and 201 Workshops

101 Workshop: March 22-23, 2022
201 Workshop: April 26-27, 2022

Register Now

  1. Overview
  2. Pricing
  3. 101 Agenda
  4. 201 Agenda

MedTech Coverage, Coding and Reimbursement 101 and 201 Workshops

101 Workshop: March 22-23, 2022
201 Workshop: April 26-27, 2022

Register Now

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.

The 101 and 201 Workshops provide an ideal environment for new Health Economics and Market Access professionals to learn about and discuss the Medicare program’s rules and processes for coverage and payment, new payment models, private payer challenges and more. The 101 Workshop will cover the basics of Medicare’s rules, while the 201 Workshop will cover broader topics, such as developing evidence for coverage and payment and managing a technology through a value-based, as opposed to a volume-based paradigm. Take a look below for a preview of this year’s sessions for the 101 and 201 Workshops. Additional details about speakers and sessions will be announced in the coming weeks.

Workshop Preview

MedTech Coverage, Coding and Reimbursement 101 Workshop:

  • Introduction to Medicare
  • Introduction to Reimbursement for Medical Technology 
  • Coverage and Coding Overview
  • Medicare Inpatient/Outpatient Payment Systems
  • Medicare Physician Fee Schedule
  • Introduction to Health Care Payment and Delivery Models 
  • The World Outside of CMS 
  • Maintaining Reimbursement: Ongoing Education and Advocacy  


MedTech Coverage, Coding and Reimbursement 201 Workshop:

  • Review of the Payment Systems Discussed in 101
  • Diagnostics Overview
  • Medicare Coverage Pathways: A Deeper Dive  
  • Strategic Positioning: Evaluating Where You Are  
  • Evidence to Support Coverage and Reimbursement 
  • Value Framework Overview
  • Quality Measures
  • Coding Tips and Strategies 
  • International Overview


Who Should Attend?

  • Health Economics & Market Access (HEMA) Professionals
  • Health Policy Professionals
  • Medical Coding and Coverage Professionals
  • Reimbursement Professionals

Registration Pricing (Per Workshop)

AdvaMed Member Companies: $300.00

AdvaMed Accel Member Companies: $200.00

Non-Members: $550.00

Government/Academic: $215.00


Discounts

Use the code BUNDLE10 to save 10% when you register for both the 101 and 201 Workshops.

AdvaMed members with 3 or more registrants can save an additional 10% off the AdvaMed member rate by using the code GROUP10.

*Discounts must be applied at time of registration

Tuesday, March 22
12:00 – 3:00 PM ET

Welcome Remarks

Introduction to Medicare
Chandra Branham, Senior Vice President & Head of Payment & Health Care Delivery Policy, AdvaMed
Richard Price, Senior Vice President, Payment & Health Care Delivery Policy & Head of Research, AdvaMed

  • 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, PhD, 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?

Medicare Inpatient/Outpatient Payment Systems – A Deeper Dive
Mark Domyahn, MBA, Partner, JD Lymon Group

  • Develop a deeper understanding of how Medicare pays for services in the hospital inpatient and outpatient settings
  • 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)
  • Discuss select recent Medicare NTAP and TPT decisions, and key considerations for companies when considering these programs

Overview of Medicare Coverage and Coding
Chandra Branham, Senior Vice President & Head of Payment & Health Care Delivery Policy, AdvaMed
Patricia Christianson, MS HSA, MBA, COC, CPC-P, CPMA, CPCO, Passel Ambit Consulting LLC

  • Introduction to Medicare coverage for medical devices
  • Understand the existing Medicare coverage pathways
  • Introduction to coding languages and different settings in which codes are used

Interactive Activity
Chandra Branham, Senior Vice President & Head of Payment & Health Care Delivery Policy, AdvaMed

Wednesday, March 23
12:00 – 3:00 PM ET

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

Medicare Physician Fee Schedule – A Deeper Dive
Marjorie Kanof, Principal, Health Policy Alternatives, Inc.

  • Understand the basic methodology used by CMS to pay for physician services
  • Learn how MedTech is incorporated into the payment methodology for physician services
  • Discuss the challenges this methodology poses for certain types of technologies

Introduction to Alternative Payment Models
Kirsten Tullia, J.D., MPH, Vice President, Payment & Health Care Delivery Policy, AdvaMed

  • 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 

Emerging Issues in Coverage of Digital Health Technologies in Medicare
Lu Zawistowich, ScD, President and Founder, CapView Strategies
Jennifer Rak, JD, MPH, Vice President, CapView Strategies

Michael Abramoff, MD, PhD, Founder & Executive Chairman, Digital Diagnostics, Inc.

Beth Keyt, Vice President Government Affairs at Pear Therapeutics 

  • 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 

Maintaining Reimbursement: Ongoing Education and Advocacy
Kate Sonnek, US Field Reimbursement Director, Medical Surgical Portfolio, Medtronic

  • Understand and communicate the “3 legs of the stool” – coding, coverage & payment
  • Learn about what a MedTech reimbursement team does to enable and protect reimbursement for products and therapies
  • Develop and leverage tools and resources for educating internal and external stakeholders

The World Outside of CMS
Mark Telles, Global Director, HE&R Electrophysiology and Director US Payer Relations, Abbott

  • 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 

Tuesday, April 26
12:00 – 3:00 PM ET

Click here to download a pdf copy of the agenda

Welcome Remarks

Review of the Medicare Payment Systems
Thomas A. Gustafson, PhD, Senior Policy Advisor, Arnold & Porter 

  • Review of IPPS, OPPS, PFS
  • Major Themes

Medicare Reimbursement for Diagnostic Tests
Thomas A. Gustafson, PhD, Senior Policy Advisor, Arnold & Porter

  • 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

Quality Measures – in Alternative Payment Models and Elsewhere
Thomas A. Gustafson, PhD, Senior Policy Advisor, Arnold & Porter 

  • How quality measurement matters for what Medicare pays providers 
  • What can we do?  Can manufacturers influence quality measures? 

Strategic Positioning: Evaluating Where You Are

Leslie Wise, J.D. – 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

Value Framework – Overview 

Laurel Sweeney, Principal, Access Strategies, LLC 

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

Wednesday, April 27
12:00 – 3:00 PM ET

Welcome Remarks

Medicare Coverage Pathways – A Deeper Dive
Chandra Branham, Senior Vice President & Head of Payment & Health Care Delivery Policy, AdvaMed

  • Understand statutory basis for Medicare coverage of an item or service
  • Examine multiple pathways to Medicare coverage
  • Explore additional Medicare coverage concepts, such as clinical trial coverage

Case Study and Interactive Activity

Chandra Branham, J.D., Senior Vice President and Head of Payment & Health Care Delivery Policy, AdvaMed

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

Coding Tips and Strategies
Patricia Christianson, MS HSA, MBA, COC, CPC-P, CPMA, CPCO, Passel Ambit Consulting LLC

  • Understand the Coding Application process for Key Code Sets ( CPT, ICD-10 PCS, HCPCS) 
  • Importance of Developing a Coding Strategy

Interactive Activity
Chandra Branham, Senior Vice President & Head of Payment & Health Care Delivery Policy, AdvaMed

Europe, A Disunion for Market Access Strategies

Paula Wittels, PhD, Programme Director with Translucency Ltd 

  • Participants will come away with a good understanding of how to meet market access challenges in three major European markets (UK, Germany, France)
  • Participants will learn how to best use clinical evidence to position themselves in major European markets 
  • Participants will learn about important distinctions in these markets compared to the US, including 
    • The need for obtaining comparative data
    • The importance of obtaining cost effectiveness data

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