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Why is reimbursement support critical?

Today's payers are increasingly cost constrained and are relying more on formal technology assessments to guide coverage decisions. These technology assessments involve a detailed review of clinical and economic evidence to drive the reimbursement process. While it is time consuming and painstaking to navigate the reimbursement labyrinth of coverage, coding, and payment, these steps are crucial to the market success of new healthcare products and medical technologies. From our hands-on experience, Mosaic understands how reimbursement drives sales in today's market environment and conversely, how sales and profits can suffer if insurance coverage is lacking. Together, insurance coverage and reimbursement are keys to a product's rapid uptake and adoption in the marketplace.

Mosaic believes that reimbursement planning is an essential part of corporate and product business planning throughout a product's life cycle. We are well positioned to offer assistance in the reimbursement realm because of our superior expertise in the following areas:

Reimbursement Strategy & Support Services

  • Developing reimbursement strategies to gain unrestricted access and maximum payment for new and often novel products
  • Conducting payer and provider surveys to identify potential hurdles to coverage and payment
  • Designing and administering reimbursement support "hotlines" for physicians, patients, and sales force personnel
  • Obtaining positive national and regional coverage policies
  • Working collaboratively with Centers for Medicare and Medicaid Services (CMS) on coding and reimbursement
  • Writing and submitting applications for new coding (e.g.: CPT, HCPCS, APC) through on-the-ground work with medical specialty societies, key opinion leaders, the AMA, CMS, regulatory attorneys, and lobbyists
  • Developing interim coding strategies for new products
  • Creating reimbursement "tool kits," including summaries of published literature, relevant codes, product descriptions, written coverage policies, payments rates by CMS and commercial insurers, and sample appeal and advocacy letters for customers
  • Implementing and staffing reimbursement hotlines and patient assistance programs to support patients and physicians who experience reimbursement denials
  • Accompanying sales force on customer site visits to present customized reimbursement information and economic data
  • Coordinating activities of patient advocacy groups to obtain positive written coverage decisions for conditions with high "social momentum"
  • Performing on-site and electronic claims and "explanation of benefits" reviews to collect primary data on payment rates by procedure, payer, and region
Health Economics
  • Designing and implementing stand-alone economic studies
  • Performing "piggy-back" economic trials for collecting economic data in conjunction with clinical trials
  • Developing decision-analytic, cost benefit, and cost effectiveness models
  • Performing return-on-investment (ROI) analyses
  • Publishing peer-reviewed health economic manuscripts
  • Developing customizable, pro-forma financial models as sales support tools
Outcomes Research and Market Positioning
  • Designing, implementing, and monitoring disease registries
  • Developing disease management strategies and tactics
  • Developing product launch strategies
  • Conducting market research to identify pressures that have the potential to affect a product's success
  • Performing quantitative in-depth literature reviews and preparing white papers
  • Performing qualitative research through interviews with international key opinion leaders and clinical experts
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