Obtaining coverage and reimbursement for a new technology requires an innovative strategic plan and tactical expertise. Quorum helps clients determine whether existing billing codes may be appropriate for their products or services. We evaluate whether coverage is available and how studies should be designed to minimize coverage barriers. We determine the exact reimbursement amount paid to hospitals, physicians, and pharmacies, and we work to change payment rates if reimbursement is not adequate.

Quorum’s coverage and reimbursement services are enhanced by our work in other service categories. Market intelligence profiles treatment standards and payer guidelines. Health economics and outcomes data measure the clinical and financial benefits attributable to new technologies.

To secure coverage and reimbursement for new technologies, Quorum offers the following services:

  • Developing reimbursement assessments and strategies. You need to know if existing codes and payment rates provide adequate reimbursement to your customers. You need to know if payers will create coverage guidelines that are different from your FDA-approved indication. Or you need to minimize coverage barriers, expedite the issuance of new codes, or optimize reimbursement to hospitals and physicians. Quorum performs environmental scans; evaluates strengths, weaknesses, opportunities, and threats; assembles alternative reimbursement pathways for consideration; and provides recommendations that optimize reimbursement for your technology.
  • Establishing coverage from third-party payers. You have FDA approval but limited coverage from payers. Or existing coverage policies don’t capture all the patient indications that benefit from the use of your test or therapy. Quorum approaches payers with evidence-based arguments, targeted messages, and sound policy recommendations to establish and broaden coverage to increase patient access.
  • Submitting code applications and changing payment rates. You want to be able to use an existing CPT code. You need to change the DRG assignment or payment level to accommodate your technology. You need a new code and payment rate because existing codes are not adequate. Quorum works with healthcare stakeholders to enlist their support, complete coding applications, and get new codes and payment rates approved.
  • Operating reimbursement call centers and patient assistance programs. You need to be able to answer customers’ and sales reps’ reimbursement questions. And you need to verify insurance benefits, challenge denied claims, and refer patients to alternative insurance options when necessary. Quorum designs and staffs call centers with reimbursement experts dedicated to your product from 9am to 8pm Eastern time. We bring down reimbursement barriers so that reps focus on sales and providers focus on patient care.