Reimbursement 101 Training: Introductory Topics

Presenter: Dr. Renée Arnold Join presenter Dr. Renée Arnold as she walks through Reimbursement and Health Economics and Outcomes Research as evidence development. This webinar aims to provide a basic understanding of the structure of the US Healthcare System and components of reimbursement and to convey how evidence development support reimbursement. Attendees will gain a deeper understanding of why and how reimbursement guides product development and ultimately which products eventually reach market. Dr. Renée JG Arnold is currently the President & CEO of Arnold Consultancy & Technology, LLC, where she develops and oversees outcomes research and affiliated software for pharmaceutical companies and the federal government. She is also an Entrepreneur-in-Residence in the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. Her special interest in evidence-based health derives from her research that deals with the use of technology to collect and/or model real-world data for use in rational healthcare decision-making by healthcare practitioners and policymakers. This seminar was presented on February 18, 2022 to an invited audience. The Catalyze program utilizes a new approach to translational research by supporting both the technical needs of an innovation and the management, commercialization, regulatory, and training requirements of the innovators developing them. Projects supported by Catalyze receive funding and advisory support through the National Heart, Lung, and Blood Institute (NHLBI), as well as project management assistance, access to technical services and expertise, and training opportunities through the Catalyze Coordinating Center. This research was funded, in part, by the National Institutes of Health (NIH) Agreement OT2 HL157844-01. The views and conclusions of the presenters are their own and should not be interpreted as representing the official policies, either expressed or implied, of the NIH. Presentation Bookmarks 0:00 Reimbursement 101 Training: Introductory Topics 1:45 Objectives 2:00 Health Economics and Outcomes Research (HEOR) as Evidence Development 7:58 Overview of the US Healthcare System Macrolevel US Healthcare Cost Trends 10:00 Payers of Interest 11:00 Introduction to Medicare 14:55 Current Medicare Molecular Diagnostics (MoIDx) Landscape 16:40 Current Medicare Durable Medical Equipment (DME) MAC Landscape 17:00 Introduction to Medicaid 20:15 Introduction to the Commercial Payer Market 21:23 Introduction to the Top 25 Commercial Payer Market 25:47 Regulatory Requirements in Reimbursement DME 25:53 DME – Coding Dynamics 29:16 Impact of Regulatory Pathway on Reimbursement 30:18 Reimbursement Codes – Introduction to Coded and Overview of Key Systems 31:37 HCPCS Coding Systems 32:15 Categories of CPT Codes 33:57 Introduction to Providers and Settings of Care – Facility & Non-Facility Definition 33:49 Reimbursement Mechanisms by Setting of Care 36:31 Interplay of Reimbursement Components 36:45 Market Access Cascade 38:00 Clinical Utility 39:36 Components of a Successful Reimbursement Strategy 41:36 Multiple Factors Influence Payer Coverage Decisions 42:45 Introduction to Payer Coverage Policies – Medical Benefit 43:54 Interpretation of Payer Coverage Policies 44:26 Introduction to Payment & Medicare Fee Schedules 45:13 Summary of Medicare Telemedicine Services 55:13 Upcoming Events