Reimbursement Services

RQM+ can help overcome government and private payer reimbursement barriers that limit broad market adoption of emerging medical technology. 

Our reimbursement research can help determine early payer reaction to new technologies. To de-risk your investment, this research can help you understand if a new product is perceived as reasonable and necessary during development phases.   

To identify market access barriers, we can also outline clinical indication differences for product coverage based on place of service (inpatient vs. outpatient hospital, clinic, or home care setting), payer mix and comparable technologies. 

Our services include:

• Strategies for coverage, coding and payment of novel technologies;
• Informatics, including dataset analysis for public and private payers;
• Market size and pricing analyses; and
• Product positioning, benchmarking and global launch strategies.

We assess the probable coverage status of new and emerging technologies among government and private health insurers. If medical coverage policies do not cover such technologies or when coverage does not exist, we can liaise with policy makers and specialty societies to advocate for coverage.

To support advocacy work, we also develop clinical dossiers, which are tools targeted to the specific interests and concerns of payers and are frequently required to secure government and private payer coverage. 

We can develop clinical study approaches and analytical tools to help demonstrate clinical effectiveness and the cost impact of new or existing technologies.

​​Health Economic Analysis

We can support development of analyses – both prospective and case-record studies – for publications that demonstrate cost effectiveness in various provider settings.

Cost Analysis

Cost analysis provides an accounting of the expenses related to a given policy or program decision and can support other economic analyses. 

Cost Effectiveness Analysis (CEA)

A CEA is a valuable tool for comparing technologies, procedures or programs with similar outcomes.

Cost Benefit Analysis (CBA)

A CBA compares the benefits and costs associated with medical technologies.

We offer a full spectrum of reimbursement services, including coding support, to help ensure optimal product adoption.

Code Applications
Healthcare Common Procedural Coding System (HCPCS) and Current Procedural Terminology (CPT) codes provide the basis for all US MedTech reimbursement. HCPCS coding can directly impact new technologies and their reimbursement.

We develop and maintain strong relationships with medical specialty societies, private payers and the Centers for Medicare and Medicaid Services. Services include developing and updating reimbursement strategies, aligning regulatory, reimbursement and business activities, evaluating risk, providing reimbursement review and input on product development documentation, and creating an efficient pathway to market.

• Clinical and patient-reported outcomes registries
• Centers for Medicare and Medicaid Services (CMS) coverage during clinical trials
• Reimbursement guides