Coverage and Reimbursement
Our preeminent coverage and reimbursement team takes on some of the most difficult payment challenges involving new technology, innovative products, diagnostic tests, and clinical services. Our experience includes initiatives relating to the coverage, coding and payment rules for all sites of care and types of products, strategies to obtain new technology and pass-through status, benefit category determinations, CPT and HCPCS coding, and national and local coverage issues, including coverage with evidence development, parallel review of new products by FDA and CMS, and interacting with CMS on problematic reimbursement issues. We also work with private payers, AHRQ, NIH, and FDA. Members of our team regularly attend the meetings of the AMA CPT Editorial Panel and the Relative Value Scale Update Committee, and we counsel clients on related strategies.
Strategic Counsel: We work closely with the firm's public policy healthcare team to advise clients on the nexus of legislative and administrative tactics and how to incorporate congressional attention in resolving reimbursement matters.
Deep Expertise: Our team consists of attorneys, an economist, healthcare professionals, scientists, and former leadership from the Centers for Medicare & Medicaid Services and the US Department of Health and Human Services.
Integrated Practice: Our coverage and reimbursement professionals work closely with our regulatory counselors to optimize the chances of successful product coverage and reimbursement.