Why Our Experience Matters - We deliver focused executable strategies to help maximize stakeholder value based on real-life healthcare industry experiences
The U.S. Healthcare delivery system, unlike any other industry, is based on the platform of a complex private and public sector third-party payer system and has become ever increasingly problematic to navigate.
Health Policy Challenges
- Government agency and reimbursement processes are not always intuitive and can lead to uncertainties and misconceptions.
- FDA approval and FDA clearance allows for commercialization. It does not mean that 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. These FDA controlled regulations affect site of care utilization, benefit category determination, coverage criteria and payment.
- Establishing a new HCPCS/CPT code does not equate to CMS coverage or payment, as these reimbursement steps are separate CMS processes.
- The cost of innovation is not an inevitable part of payment calculation processes.
WHG Consulting Services - Our innovative approach to health policy consulting is based on a core set of essential strategy analytics and focused reimbursement pathways.