Reimbursement and Coding Development
As the healthcare industry shifts to a value based delivery system, both providers and health plans grapple with integrating quality measurements, outcomes, and reporting into their infrastructure while maintaining financial strength.
Many health plans are transitioning from transactional and volume-based reimbursement models to collaborative, value-based models focused on improving patient outcomes and satisfaction. How health systems and providers choose to respond to this transition and the compensation models they employ will significantly affect their viability and growth.
Senergene assists health plans and providers with understanding how to approach the nuances of these changes. Our experienced team of expert clinicians and healthcare business strategists collaborates with you to create customized, innovative solutions:
- Contract Reimbursement Design
- Fee Schedule Development
- Medical Coding
- Overpayment Recovery
- New and Existing Coding Applications
- Out of Network Analysis and Management
- Price Negotiations
- RFP Development
- Rate Benchmarking
- Reimbursement Strategies
- Value Based Model Development
Additional Reimbursement Services
- Commercialization of Services and Products
When companies launch new diagnostic tests or products, a critical step in the launch includes securing public and private reimbursement. The reimbursement strategy involves applying to Medicare, private payers, and Medicaid for specific coverage policies, codes, and payment. Senergene assists companies with the development of a strategic managed care and reimbursement plan for payer and industry adoption. We determine potential BCBSA TEC, Medicare, and other private payer coverage policies, estimate payer payments outline the steps in applying for new codes and provide a detailed timeline for obtaining favorable insurance policies.
- Corporate Reimbursement Strategy Development:
Companies frequently request reimbursement input to their corporate strategic planning activities. Typically, we analyze how US health care reform, Medicare and Medicaid policy changes, and private reimbursement trends shape pricing and market penetration for specific product segments. Based on the trends, we may suggest areas for future product development.