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Product Experience

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Biologics
Biologic allograft products such as blood, bone, skin and tendons have distinct reimbursement challenges, particularly when it comes to coding. Reimbursement Principles has experience with a variety of human and animal grafting products, working through complex coding and coverage problems. We have been highly involved with new HCPCS code applications for biological products, including stem cells, human connective tissue, islet cell transplants, fat grafts for reconstructive surgery and xenograft tissue for heart valve replacement procedures.
Cardiovascular

Reimbursement Principles has extensive experience with reimbursement related issues for a diverse list of cardiovascular services and products. We have successfully implemented reimbursement services for over 30 cardiovascular clinical trials. This includes preparing clinical trial reimbursement guides, challenging non-payment, monitoring progress with Medicare contractors, and cataloging hospital and physician charges during the study.

As leaders in this sector of the industry, Reimbursement Principles fully understands the significant subtleties involved with cardiovascular related services and medical devices. We successfully secured new Diagnostic Coding that was not previously identified through the ICD-9-CM (now ICD-10-CM) Coding nomenclature, and authored a multi-procedure coding guide for one of the major specialty societies. We have developed laptop- and iPad-based sales calculators to assist sales representatives with presenting the economics of cardiovascular procedures to hospitals, and conduct dozens of custom coding clinics for customer groups.

  • Ambulatory Cardiac Telemetry
  • Annuloplasty Procedures
  • Aortic Aneurysm Grafts
  • Aortic Aneurysm Stents
  • Bedside Cardiac Defibrillators
  • Blood Clotting Biologics
  • Cardiac Ablation
  • Cardiac Defibrillators
  • Cardiac Markers as Predictors of Myocardial Infarction
  • Cardiac Rhythm Management
  • Cardiac Valve Procedures
  • Cardiac Perfusion
  • Carotid Artery Stenting
  • Chronic Total Occlusion Catheter
  • Clinical Trial Reimbursement for Transcatheter Heart Valve Repair/Replacement
  • Coronary Artery Stent
  • Coronary Thrombectomy
  • Deep Vein Thrombectomy
  • Deep Vein Thrombosis Diagnostic Procedure
  • Drug Coated Coronary Stents
  • Embolic Protection Devices
  • Endoscopic Vein Harvesting
  • Endovascular Aortic Graft
  • Endovascular Laser Treatment
  • EP (Electrophysiological) Studies
  • Esophageal Doppler Monitor
  • Extracorporeal Membrane Oxygenation (ECMO)
  • Gene Therapy for Heart Failure
  • Genetic Testing for Sudden Cardiac Death
  • Heart Procurement System
  • Implantable Cardiac Defibrillator (ICD)
  • Ischemia Detector
  • In Stent Restenosis Treatment
  • Living Heart Transplant
  • Microwave Ablation for Atrial Fibrillation
  • Minimally Invasive CABG Procedures
  • Minimally Invasive Cerebral Artery Thrombectomy
  • Minimally Invasive Coronary Thrombectomy
  • Minimally Invasive Mitral Valve Repair
  • Mobile Cardiac Outpatient Telemetry (MCOT)
  • MRI Coils
  • Non-invasive Tachyarrythmia Stress Test
  • Occlusion Coils
  • Patent Ductus Ateriosus
  • Patent Foramen Ovale (PFO) for the Management of Recurrent Stroke
  • Percutaneous Coronary Interventions
  • Percutaneous Mitral Valve Repair
  • Percutaneous Repair of Total Coronary Occlusion
  • Percutaneous Thrombectomy
  • Peripheral Artery Stenting
  • PICC and CVC Lines
  • Radiofrequency Ablation
  • Remote Cardiac Monitoring
  • Reperfusion
  • Sleep Apnea Studies
  • Stress EKG
  • Valvuloplasty
  • Vascular Sealants
  • Venous Insufficiency Treatments (Varicose Veins)
  • Ventricular Assist Device (VAD)
    • Post Cardiotomy
    • Bridge to Transplant
    • Destination Therapy
Clinical Laboratory Tests
Reimbursement Principles has extensive experience with clinical laboratory tests. This area of medicine is undergoing unprecedented changes with coding and coverage policies. Reimbursement Principles is at the forefront of these changes, highly involved with the American Medical Association’s Molecular Pathology Coding Workgroup. We assist a variety of manufacturers of clinical laboratory test products navigate a highly complex reimbursement process.
Diabetic Care/Endocrinology

Reimbursement Principles has deep, extensive experience with diabetic products and supplies used by healthcare professionals as well as by the patient in their home setting. Reimbursement Principles has developed coding for several diabetic products such as glucose meters, and decubitis wound care.

  • Arteriovenous Fistula/Graft
  • Diabetes Self-Management Training
  • Diabetic Ulcer Wound Healing
  • Glucose Monitoring System
  • Pancreatic Cell Transplant
  • Vascular Access Graft
Diagnostic Testing

Diagnostic testing has unique reimbursement attributes which Reimbursement Principles understands. Whether the diagnostic procedure involves new imaging techniques such as 3D MRI or Ultrasound, is a new multiplex laboratory assay test to diagnose genetic disorders, or a rapid diagnostic point-of-care test, Reimbursement Principles has the experience and clinical contacts in this area of medicine. We have been involved with multiple clinical trials, secured new and unique procedural coding for various clinical and pathology services and implemented successful strategies for emerging high tech diagnostic equipment.

  • 3-D Ultrasound Breast Cancer Diagnostic
  • Ambulatory pH Monitoring
  • Anorectal Manometry
  • Asthma Diagnostic and Management System
  • Blood-based Cancer Antigen Testing (Breast, Colorectal, Lung & Prostate)
  • Bone Density Studies
  • CO2 Monitoring
  • Cardiac Markers
  • Clinical Laboratory Assay (EBV and CMV)
  • Deep Vein Thrombosis Diagnostic Procedure
  • Drug-resistant Genotyping
  • ELISA Test
  • Esophageal Function Test
  • Esophageal Manometry
  • Genetic Testing
  • Glucose Monitoring System
  • Herpes Simplex Virus
  • Mobile Cardiac Outpatient Telemetry (MCOT)
  • Molecular Diagnostics
  • MSI Bladder Assay for Bladder Cancer Recurrence
  • Non-invasive Heart Diagnostic Device
  • Non-invasive Tachyarrythmia Stress Test
  • Pharmacogenetic Testing
  • Photodiagnosis for Bladder Cancer Screening
  • Point of Care Testing/Office-Based Lab Tests
  • Point of Service Colorectal Cancer Screening
  • Rapid HIV Testing
  • Skin Cancer Screening Tests
  • Stress EKG
DMEPOS

Durable Medical Equipment Prosthetic and Orthotic Supplies face unique reimbursement challenges with Medicare and private payers. Reimbursement Principles has extensive experience resolving reimbursement barriers to market for a variety of durable medical equipment items as well as orthotic and prosthetic devices. We have extensive experience with Medicare’s four DME contractors. In addition, we routinely interface with PDAC to verify coding for supply and drug items. Regularly, we assist clients with preparing HCPCS coding applications and ensure that these products are paid fairly, and in line with manufacturer pricing.

  • Apnea Monitors
  • Compression Garments
  • Decubitus Wound Care
  • Diabetic Supplies
  • Electrical Stimulation for Treatment of Osteoarthritis of the Knee
  • Enteral/Parenteral Supplies
  • Fixation Devices
  • Gastrostomy Feeding Tube
  • Glucose Monitoring System
  • Hearing Aids
  • Homecare Training Videos for Total Hip and Knee Replacements
  • Infusion Pumps
  • Inhalation Delivery Systems
  • Orthopedic Hardware
  • Orthopedic Soft Goods
  • Oscillating Hospital Specialty Bed
  • Osteogenesis Stimulators
  • Pediatric Immobilizers
  • Drainage Catheter and Home Kit
  • Spinal Orthosis
  • Strapping and Casting Products
  • TENS/PENS
  • Tinnitus Treatment
Gastroenterology

Gastroenterology procedures are rapidly evolving from invasive surgical procedures to noninvasive procedures. With these changes reimbursement issues erupt, particularly when a procedure transitions from the hospital inpatient setting to outpatient, ASC or physician office based procedures.

Reimbursement Principles has been at the forefront of several minimally invasive new gastroenterology procedures. For example, we have been instrumental in securing new CPT codes, running reimbursement for multiple clinical trials, convening physician and payer focus groups to develop coverage for these emerging surgical technologies, and providing national preauthorization hotlines to support new product launches.

  • Ambulatory pH Monitoring
  • Anorectal Manometry
  • Autologous Stem Cell Therapy for Treatment of Complex Perianal Fistulas
  • Bariatric Procedures
  • Capsule Endoscopy
  • Colonoscopes
  • Confocal Laser Imaging by Endoscope of Mucosa in the GI Tract
  • Endoscopy
  • Esophageal Function Test
  • Esophageal Manometry
  • Gastrostomy Feeding Tube
  • Gastroesophageal Reflux Disease (GERD)
  • MRI Diagnostics for Iron Chelation
  • MRI of Abdomen to Monitor Thalassemia
  • Natural Orifice Transendoscopic Surgery (NOTES)
  • Non Invasive Breath Test to Manage Liver and GI Disorders
  • Transendoscopic Incisionless Fundoplication
  • Transendoscopic Bariatric Revision
  • Transcutaneous Electrical Stimulation Device for Relief of Nausea and Vomiting
Gynecology/Women's Health

Reimbursement Principles has been involved with multiple, new technologies to treat uterine fibroids, breast cancer diagnostics and reconstruction. We have also assisted clients with diagnostic tools for preterm labor and eclampsia. Recently Reimbursement Principles was instrumental in securing new CPT coding for a blood based test to determine if ovarian tumors are malignant or benign prior to the surgical intervention.

  • 3-D Ultrasound Breast Cancer Diagnostic
  • Benign Breast Tumor Destruction
  • Breast Biopsy System
  • Breast Reconstruction Surgery
  • Dysfunctional Uterine Bleeding Treatments
  • Early Identification of Cervical Cancer
  • Endometrial Ablation
  • Genetic Testing for Breast Cancer
  • Microwave Therapy for Breast Cancer
  • MRI Guided Uterine Fibroid Ablation
  • Radiofrequency Ablation of Uterine Fibroids
  • Preterm Labor Monitoring
  • Stress Urinary Incontinence Therapies
  • Thermoablation for Breast Cancer
  • Thermoablation for Uterine Fibroids
  • Transcutaneous Electrical Stimulation Device for Relief of Nausea and Vomiting
  • Ultrasound Ablation of Fibroids
  • Urge Incontinence Therapies
  • Uterine Artery Embolization
  • Uterine Prolapse Repair
Neurology

Reimbursement Principles has been involved with a variety of neurological products being introduced into the US healthcare market. These products range from high tech implantable devices for Parkinson’s disease and spinal cord stimulators for pain control to diagnostic tests for cognitive function. Reimbursement Principles has provided reimbursement support during clinical trials for several neurology based product lines and has been involved in developing and implementing successful reimbursement strategies. Reimbursement Principles is also involved with several products in development for stroke diagnosis and treatment.

  • Continuous Peripheral Nerve Blocks
  • CSF Shunts
  • Deep Brain Stimulation
  • Doppler Bubble Monitor
  • Functional Electrical Stimulation Treatments for Spinal Cord Injuries
  • Infusion Pump
  • Intracranial Neurostimulator
  • Magnetic Resonance Stimulation for Parkinsons/Alzheimers
  • Neuromodulation for Low Back Pain
  • Non-invasive Pain Management Treatment
  • Programmable CSF Shunt Valve
  • Shoulder Subluxation Device for Stroke Patients
  • Spinal Cord Stimulators
  • Temperature Management Systems
Oncology

Reimbursement Principles was also highly involved with a photodynamic therapy for esophageal cancer that involved an implant activated by light therapy to shrink the tumor. In addition, Reimbursement Principles is involved with optical and endoluminal microscopy technology used to ensure tumor margins are clean during tumor excision surgical procedures. We have provided a national preauthorization hotline to obtain rapid preauthorization from private payers of select treatments.

  • Blood-based Cancer Antigen Testing (Breast, Colorectal, Lung & Prostate)
  • Brachytherapy Seeds
  • Chemoembolization
  • Cryosurgery
  • Early Identification of Cervical Cancer
  • Infusion Pump
  • Laser Interstitial Thermal Therapy for Prostate and Brain Cancer
  • Light-based Imaging System for Cancer Screening
  • Microwave Therapy
  • Microspheres Administration for Non Resectable Liver Tumors
  • MSI Bladder Assay for Bladder Cancer Recurrence
  • Optical Coherence Tomography
  • Orphan Biologic Drug for Photodynamic Therapy
  • Photodiagnosis for Bladder Cancer Screening
  • Photodynamic Therapy
  • Drainage Catheter and Home Kit
  • Radiofrequency Ablation
  • Select Internal Radiation Therapy (SIRT)
  • Skin Cancer Screening Tests
  • Thermoablation Treatments
Ophthalmology

Reimbursement Principles has experience with a variety of ophthalmological products used to diagnose and treat eye disorders. We have worked on several products to treat wet and dry macular degeneration and surgical instrumentation for corneal repairs. Reimbursement Principles has also provided reimbursement support for an optical implant to restore vision in visually impaired or blind patients

  • Artificial Cornea
  • Intraocular Lens Implants
  • Keratoprosthesis
  • Optical Coherence Tomography
  • PRK/RK/LASIK Surgeries
  • Retinal Reattachments
Orthopedics and Spine

Reimbursement Principles has extensive experience helping manufacturers of products for Orthopedic and Spine procedures. The majority of our experience involves products/procedures for spinal disorders including degenerative disk disease, spinal cord injuries and spondylosis, as well as hip implants and custom artificial knee implants. We have provided a national preauthorization hotline to support the launch of a new spine product. Reimbursement Principles has developed CPT and HCPCS codes for a variety of orthopedic procedures. We have assisted several manufacturers with reimbursement during IDE clinical trials. We have also been highly involved with allograft products used in orthopedic procedures such as ACL repairs. See our section on biologic products for additional information on our experience with allograft products.

  • Arthrofibrosis of the Knee
  • Arthroscopic Knee & Shoulder Repair
  • Arthroscopic Probe
  • Autologous Chondrocyte Transplantation
  • Bone and Soft Tissue Anchors
  • Bone Graft Fillers
  • Bone Growth Stimulators
  • Carpal Tunnel Release System
  • Computer Assisted Musculoskeletal Surgical Navigational System
  • Cranial Implants
  • Discogenic Treatments
  • Distraction Osteogenesis
  • Electrical Stimulation for Treatment of Osteoarthritis of the Knee
  • Fixation Devices
  • Homecare Training Videos for Total Hip & Knee Replacements
  • Hyaluronic Acid Injections (for Osteoarthritis)
  • Implantable Prosthetic Hand Grasp System for High Level Spinal Cord Injuries
  • Interpositional Knee Implant
  • Lumbar Disc Replacement
  • Open Disectomy
  • Orthopedic Hardware
  • Orthopedic Soft Goods
  • Percutaneous Discectomy
  • Percutaneous Vertebroplasty
  • Spinal Orthosis
  • Vertebral Disc Replacement
Otolaryngology/Audiology

Reimbursement Principles has unprecedented reimbursement experience for a variety of ENT products including cochlear implants, bone anchored hearing aids, implantable hearing aids, and auditory brainstem implants. Reimbursement Principles also has been highly involved with developing CPT codes for professional services associated with these hearing devices.

  • Auditory Brain Stem Implant
  • Aural Rehabilitation
  • Bone Anchored Hearing Aids
  • Cochlear Implants
  • Dysphagia
  • Implantable Hearing Aid Systems
  • Middle Ear Hearing Prostheses
  • Speech Therapy
  • Tinnitus Masking Device
  • Vestibular Function Test
Respiratory

Reimbursement Principles has assisted several manufacturers of respiratory device and therapeutics. Reimbursement Principles has been involved with several products designed to diagnose asthma, and prevent asthmatic attacks. Reimbursement Principles has published a cost effectiveness paper in a peer reviewed journal demonstrating the clinical and economic efficacy of early identification of asthma attacks, avoiding costly emergency room encounters.

  • eNO for Asthma Management
  • CO2 Monitoring
  • Confocal Laser Imaging by Endoscope of Mucosa in the Pulmonary Tract
  • Endobronchial Valve
  • Endobronchial Stent
  • Nebulized Therapy
  • Radiofrequency Ablation of Pulmonary Tumors
Telemedicine

Telemedicine is a new frontier for medicine, and there is tremendous potential to save health care expenditures while increasing patient care by avoiding expensive hospital and physician visits. Yet, despite this promise, reimbursement elements, coding, coverage and payment lag this promising technology. Reimbursement Principles has been involved with a variety of telehealth/telemedicine products, working to create a more friendly reimbursement environment.

  • Hospital Bed Side Patient Monitor for Real Time Data on Patient Vital Signs
  • Emergency Department and Physician Office Based Patient Hand Held Device for Vital Sign Monitoring
  • Remote Patient Monitor for Blood Glucose Level, Blood Pressure, Weight, Respiratory Rate and Patient Diary
  • Remote Physician Office Visits
Urology

Reimbursement Principles has been involved with a variety of urological products designed to diagnose or treat urology related problems. From simple products such as drug coated catheters, to implantable stimulators for bladder control, Reimbursement Principles has provided clinical trial support, developed reimbursement strategies and implemented the strategic plans to develop the market.

  • Artificial Bladder Sphincter
  • BPH Treatments
  • Brachytherapy for Prostate Cancer
  • Collagen Implant Injections
  • Cryosurgery
  • Implantable Functional Electrical Stimulation (Bladder/Bowel System)
  • Kidney & Bladder Stone Retrieval Device
  • Kidney Stone Retrieval System
  • Laser Interstitial Thermal Therapy for Prostate Cancer
  • MRI Coils
  • Radiofrequency Ablation of Renal Tumors
  • Renal Dialysis
  • Stress Urinary Incontinence Therapies
  • Thermoablation
  • Urethral Stents
  • Urge Incontinence Therapies
  • Urinary Retention
Other Experience

Reimbursement Principles has worked on a variety of medical products that span multiple areas of medicine. We have assisted multiple products and some drugs that are used to treat rare disorders, falling into an Orphan Device status with the FDA.  Payers have particular concerns about Orphan Devices.  Reimbursement Principles understands the payer concerns and is well versed in how to educate the payers on the unique features of these products.

Reimbursement Principles also has experience with drug/device combination products. Reimbursement Principles worked extensively on a drug delivered through a nebulizer to treat chronic COPD conditions.

  • Artificial Facial Bone Reconstruction
  • Blood Clotting Biologics
  • Breast Reconstruction Surgery
  • CO2 Laser-Based Procedures
  • Compounded Drugs
  • Conscious Sedation Technologies
  • CPAP Face Masks
  • Cryosurgery
  • Decubitis Wound Care
  • Diabetes Self-Management Training
  • Diabetic Ulcer Wound Healing
  • Drainage Catheter and Home Kit
  • Drug Delivery Patch
  • Endovascular Laser Treatment
  • Gastrostomy Feeding Tube
  • Glucose Monitoring System
  • Harmonic Scalpel
  • Humanitarian Device Exemption (HDE)
  • Implantable Functional Electrical Stimulation (Bladder/Bowel System)
  • Implantable Prosthetic Hand Grasp System
  • Infusion Pump for Chelation Therapy
  • Infusion Pump for Pain Management
  • Inhalant Delivery Systems
  • Intra-Abdominal Pressure Monitoring Kit
  • Light Based Treatment for Nail Fungus
  • Microwave Therapy
  • MRI Coils
  • MRI Diagnostics for Iron Chelation
  • MRI of Abdomen to Monitor Thalassemia
  • Needle-free Drug Delivery System
  • Organ Procurement System
  • Oscillating Hospital Specialty Bed
  • Platelet Gel Compounding
  • Radiofrequency Ablation
  • Renal Dialysis
  • Sleep Apnea Studies
  • Sublingual Immunotherapy For Allergies
  • Temperature Management Systems
  • Therapeutic Apheresis for Hepatitis C
  • Thermoablation Treatments
  • Tissue Adhesives and Surgical Sealants
  • Transcutaneous Electrical Stimulation Device for Relief of Nausea and Vomiting

 

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