M&A Due Diligence to Maximize Stakeholder Value
Evaluating Reimbursement and Market Access Policies - One of the most critical and challenging analytics of healthcare M&A due diligence
WHG provides guidance through all 7-reimbursement steps - from diagnosis, treatment plan, site of care, and benefit category to coding, coverage and payment.
Often healthcare due diligence can miss critical analytics at the beginning of the 7-step reimbursement process and focus only on coding, coverage and payment.
No, coding, coverage or payment can occur without a defined benefit category that is site of care specific.
WHG understands the health policy challenges and misconceptions that can affect transactions.
WHG can help clients prepare for a successful due diligence process.
Reimbursement and Market Access Challenges That Affect Transactions
Government agency regulations and reimbursement processes are not intuitive and lead to uncertainties and misconceptions.
FDA approval and FDA clearance allows for commercialization. It does not mean a product is covered or eligible for reimbursement by Medicare, Medicaid, or commercial insurance.
FDA approved indications for use and FDA product coding can result in potential downstream consequences with significant reimbursement implications that can affect site of care utilization, benefit category determination, coverage criteria and payment.
Establishing new IPPS/HCPCS/CPT codes does not equate to CMS coverage or adequate payment; these reimbursement steps are separate CMS processes.
The cost of innovation is not an inevitable part of payment calculation processes.
WHG Core Set of Strategy Analytics and Reimbursement Pathways
Strategy Analytics - Comprehensive Medicare, Medicaid and commercial insurance reimbursement pathway analysis.
- Guidance through all seven-reimbursement steps - from diagnosis, treatment plan, site of care, and benefit category to coding, coverage and payment.
- CMS utilization, mean costs and crosswalk data analytics are key drivers of HHS and CMS decision-making trends.
Reimbursement Pathways – We identify the foundation of reimbursement hurdles and opportunities.
- Prioritize milestones to support policy strategies and help maximize stakeholder value.
- Execute actionable Agency and Capitol Hill strategies and tactics.