HARNESSING THE POWER OF OUR EXPERIENCE IN POLICY, HEALTH ECONOMICS AND REIMBURSEMENT STRATEGY TO FUEL YOUR JOURNEY TO MARKET.
A GYN procedure was initially placed in Group 4 under the old ASC payment system. In addition, the company launched the first generation device with an ASP that was insufficient once the product was redesigned. The low reimbursement made performing the procedure a non-starter in the ASC as the reimbursement was less than the cost […]
A novel technology in the GERD space was launched with an unlisted CPT code, which was automatically placed in the lowest paying hospital outpatient APC for that space. The unlisted code was excluded from payment by Medicare in the Ambulatory Surgery Center (ASC). The JD LYMON Solution: We prepared a New Tech APC application and met […]
A specialty biopharmaceutical company developed two drugs for the treatment of rare diseases and wanted to seek premium payment in a predominantly Medicaid market. The JD LYMON Solution: We prepared transitional pass-through and HCPCS applications for two infusion drugs. Results: The transitional pass-through status was granted for both drugs enabling a payment mechanism available upon drug […]
The AMA created a new category of CPT codes in the vascular space, bundling previously reported component codes. The proposed rules reported payment inequity in the hospital outpatient department for procedures using multiple devices in a single surgical session. The JD LYMON Solution: We formed and led a workgroup of device manufacturers who had a vested […]