reimbursement summary


Research the possible reimbursement strategy for your hypothetical innovation and prepare a sample reimbursement summary (see Table 4.3.3 in Chap

4.3) that describes the closest comparable procedure and its relevant codes (ICD-9, CPT, DRG, APC, as applicable) and payment(s). In about 500

words, describe how you would advocate for favorable reimbursement (see Chap 5.6) and who you may need to lobby (for LCD, CPT code, private payor

reimbursement, etc.). Be sure to describe if your innovation needs new code(s) and who approves these codes. Unless you are an expert in

reimbursement, this research will challenging (but with time you will find the answers). At the end of each chapter you have suggestions “Where to

Look” under “Getting Started”.

Hint: Utilize multiple resources to cross reference your findings to verify that the results are still valid (reimbursements in the cardiac arena

changes quickly compared to other therapeutic areas).

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