clinivation, Inc. - Reimbursement

Reimbursement is an increasingly important consideration in the development and marketing of medical products. Crafting a reimbursement strategy early in your product's development cycle will help you build a case for your product and help support positive coverage and reimbursement decisions.

As the largest single healthcare insurer in the U.S., Medicare has a profound influence on the healthcare market. The Centers for Medicare and Medicaid Services (CMS) formulates national and local coverage policy and sets reimbursement rates for facility and physician providers. Commercial payers often follow the lead set by CMS when determining their own coverage and payment guidelines.

Regardless of the payer, three basic steps must occur for the product or procedure to be considered reimbursable:

In general, the complexity and integration of these processes are significant challenges for manufacturers seeking to bring products to market.

The clinivation reimbursement team will evaluate current coverage policies, billing codes, and estimated payment levels as part of early stage planning and begin developing the right strategy for your product to address them. We also work with decision-makers including government agencies, specialty medical societies, and public and private payers to ensure that products are appropriately reimbursed in the marketplace.

Clinivation will work with you to develop and implement a strategy to achieve optimal reimbursement levels.