You are here

Medicare Reimbursement Policy

Background

Medicare establishes and regularly updates its rules governing the payment systems that it uses to pay providers and suppliers of Medicare-covered items and services, including hospitals, doctors, durable medical equipment suppliers and others.  These rules are typically updated on an annual basis. In addition to updating a payment methodology or payment rates, Medicare’s payment rules often contain additional policies that can significantly impact Medicare providers and suppliers.

AdvaMed Efforts

AdvaMed reviews and analyzes these payment rules, and engages with the various AdvaMed work groups in order to develop substantive comments for Medicare to improve or clarify the policies that will likely affect our member companies.  

Coverage & Coding Best Practice Guides 

The Coverage & Coding Overview and Best Practice Guides resource is a detailed overview describing the coding system and guidelines for device manufacturers seeking CMS coverage. These documents provide essential information for device manufacturers to consider concerning coverage and payment, such as:

  • CMS coverage policy guidelines and criteria
  • The interplay between CMS and FDA
  • Key coverage considerations for developing an engagement strategy
  • CPT, HCPCS, and ICD coding information
  • Key coding considerations for device manufacturers
  • Characteristics of a successful reimbursement strategy
  • Medicare coverage landscape and processes 
    • National Coverage Determinations (NCDs)
    • Local Coverage Determinations (LCDs)
  • Successful engagement with Medicare Administrative Contractors (MACs)
  • Parallel Review overview and criteria
  • Case Studies: Cologuard and TAVR

To access the guides and webinar content, click here