Wells Health Group
  • About Us
  • Health Policy
    • CPT/HCPCS Coding
    • FDA - Emergency Use Authorization (EUA)
    • Medicare 101
  • Government Relations
  • M&A Advisors
  • Leadership
  • Community
  • Contact
One of the most critical and challenging analytics of healthcare M&A due diligence is evaluating the health policy strategy component = Reimbursement

Picture
M&A Due Diligence to Maximize Stakeholder Value
  • Are the client’s reimbursement coding, coverage and payment pathways solid and sustainable?
  • Solid and sustainable reimbursement coding, coverage and payment pathways?
  • How well is the client positioned for funding or coverage challenges
  • How vulnerable is the client to the inevitable shift from fee-for-service to value-based payments?
WHG understands the health policy challenges and misconceptions that can affect transactions.

WHG can help clients prepare for a successful due diligence process.

Health Policy Challenges That Can Affect Transactions
Picture
  • Government agency regulations 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 with significant reimbursement implications.
    • Drugs covered under Part B vs. Part D? 
    • New HCPCS J-Code and/or pass-through status?
    • New drugs and new technologies covered under Part A MS-DRG vs. New Technology Add-On Payment (NTAP)?
    • These FDA controlled regulations 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.
  • Cost of innovation is not an inevitable part of payment calculation processes.​


WHG Core Set of Essential Strategy Analytics
  • Comprehensive Medicare, Medicaid and commercial insurance reimbursement pathway analysis
  • ​Categorize the foundation of the opportunity and/or pinch points
  • Identify the current political and policy landscape
  • Prioritize actionable pathway and milestones to maximize stakeholder value

Due Diligence
  • We know what questions to ask
  • We know how to translate the answers and understand the consequences
  • We know how to prepare clients for policy questions
  • We know how to craft succinct and powerful messaging to best articulate their position  

WHG assist in evaluating a transaction's potential to help maximize stakeholder value based on real-life experiences

Wells Health Group
565 Pennsylvania Ave. NW Suite #614     
Washington, D.C. 20001
info@wellshealthgroup.com
Office:  202.629.4366
Contact us to discuss how we can help
Proudly powered by Weebly