Tag Archives: coverage

Reimbursement Report

A Major National Health Plan Medical Director Shares Insights on How Coverage Decisions are Made

By Jessica Holmes
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This Q&A session, with an active Regional Medical Director involved in traditional health plan policy and payment development, as well as emerging value-based models, reveals important information and attitudes toward coverage of new/existing technologies and standards of evidence.

This Q&A session, with an active Regional Medical Director involved in traditional health plan policy and payment development, as well as emerging value-based models, reveals important information and attitudes toward coverage of new/existing technologies and standards of evidence.

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Reimbursement Report

The Appeals Process

By Elizabeth Brown, MD
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Presenting clinical evidence to payers is the most efficient method of gaining coverage. But when this strategy is unsuccessful or hits a wall, a ground-up approach is required, relying on consistent and steady support from local physician champions that demonstrates broad acceptance of a technology.

Presenting clinical evidence to payers is the most efficient method of gaining coverage. But when this strategy is unsuccessful or hits a wall, a ground-up approach is required, relying on consistent and steady support from local physician champions that demonstrates broad acceptance of a technology.

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Reimbursement Report

Let’s Start at the Very Beginning

No matter how tortuous the path to durable coverage and adequate payment for a new technology, the bedrock of the entire reimbursement process relies on the clinical evidence of safety and effectiveness. This inaugural blog post is the first in a series focused on the key reimbursement issues in this fluid health care environment.

No matter how tortuous the path to durable coverage and adequate payment for a new technology, the bedrock of the entire reimbursement process relies on the clinical evidence of safety and effectiveness. This inaugural blog post is the first in a series focused on the key reimbursement issues in this fluid health care environment.

Continue reading