Services

Reimbursement

Uniquely Qualified Reimbursement Experts

Using our experience working directly with insurance companies, WCRO is intimately familiar with the necessary evidence required to achieve coverage. Our study designs are built to satisfy your regulatory agency and the agencies that determine coverage.

Our Approach 

Coding

WCRO understands the numerous types of codes used by coverage-deciding agencies, private payers, facilities and physicians.

WCRO Capabilities:

  • Coding strategy for use by stakeholders
  • Early payer and market research
  • Experience obtaining new codes as necessary
  • Produce Analysis for proper coding

Reimbursement

To ensure optimal payment, WCRO offers:

  • Early payer and market research to identify possible roadblocks to reimbursement
  • Patient advocacy and payer coverage support
  • Strategies for reimbursement pathways

Clinical Trial Reimbursement Support

Clinical trial reimbursement requires a specific approach.

WCRO Capabilities:

  • Support for sponsors and sites
  • Analysis of possible coverage for trial
  • Claims submission assistance
  • Appropriate Coding

Our Therapeutic Specialties

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Cardiovascular

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Dental

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Gastroenterology & Urology

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General & Plastic Surgery

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Orthopedics & Spine

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Wound Care & Dermatology

Frequently Asked Questions

What is medical device reimbursement?

Reimbursement, as it applies to medical devices, is defined as the payment a third-party public or private insurer pays a healthcare provider for costs or payments the provider incurred while using a medical device or performing a procedure. It can often be a variable and challenging process. Working with an experienced CRO, like WCRO, can take some of the challenge away.

How is a new CPT code developed?

Any interested party may apply for changes to CPT for new or revised codes to the CPT Editorial Panel. Here is a simplified outline of what happens. First, AMA staff determines if the request is new, and, if it is, they refer the application to the CPT Advisory Committee for evaluation and commentary. This process takes at least three months. Next, the AMA staff refers the application to the CPT Editorial Panel, a 17-member panel that meets three times each year and addresses nearly 350 major topics per year. Next, the CPT Editorial Panel takes an action
and makes preliminary approvals, which can result in several different outcomes from adding a new code or revising existing nomenclature to rejecting the request. AMA staff informs the applicant of the CPT Editorial Panel’s decision. Approved codes are then referred to AMA/Specialty Society Relative Value Update Committee (RUC) and the new or revised CPT are implemented. This entire new CPT Code application process can take from 18 to 24 months. Consult WCRO for a more detailed explanation and how we can assist you in your reimbursement pathway.

How do I conduct a reimbursement landscape assessment?

A reimbursement landscape assessment is a snapshot of the current coverage, coding and payment landscape for a particular technology or procedure. It tells you what reimbursement challenges and opportunities exist for the adoption of their product. Common elements include determining payer coverage status, identifying existing coding
used by stakeholders, determining payment assigned to existing codes, assessing evidentiary needs to show improved outcomes/cost-effectiveness of new technology and preparing findings and recommended action steps. An experienced CRO, like WCRO, is critical in appropriately and efficiently performing this crucial review.

Maximize Coverage With WCRO