ACTION
STEP |
GOAL |
DESCRIPTION |
| 18 |
Gain national payor acceptance |
Obtain reimbursement. Leverage code and value approvals so as to obtain expanded payor coverage. |
| 17 |
Achieve National Sales Targets |
Maximize Return On Investment with a sales and marketing program to
those groups supporting payor
acceptance and reimbursement |
| 16 |
Obtain appropriate reimbursement amount |
USTR will guide the activities required for the purpose of obtaining the appropriate dollar amount assigned to the code. |
| 15 |
Obtain Code |
Code approval starts the next sequence of actions, designed to further increase recognition, acceptance, support and reimbursement. |
| 14 |
Submit Application for National Code |
The application must be viewed as a marketing item that sells the provider as integral to the diagnosis and treatment of the medical condition. The application must be structured for the code decision making body and submitted via the appropriate medical society. |
| 13 |
Increase regional reimbursement coverage |
Expand regional coverage utilizing the EOB analysis to “bandwagon effect“ payer acceptance and reimbursement. |
| 12 |
Presentation to Payers |
Make sales presentations to medical directors utilizing the completed surveys. |
| 11 |
Contact regional payers |
Survey medical directors to discover the drivers to get the procedure covered under their individual health plans. |
| 10 |
Submit Claims |
Obtain feedback from providers related to claims processing. Obtain utilization data. Develop Physician and Hospital Reimbursement Guides for existing and
unspecified codes. |
| 9 |
Assist providers |
Implement an automatic website email and 1-800 system to respond to provider inquiries related to claim procedures. Develop a physician training program. |
| 8 |
Market the code |
Get articles published in trade journals that identifies the code and reimbursement values and increases awareness of the provider as a first-tier provider for diagnosis and treatment of the medical condition. |
| 7 |
Train Sales Staff |
Train sales staff and dealers to explain reimbursement issues to their customers and utilize reimbursement information to accelerate sales. |
| 6 |
Accreditation of providers and devices |
USTR will assist the association to create a program designed to obtain:
- Payor acceptance that the provider is the
appropriate entry point for the diagnosis and treatment of the medical condition
- Payor acceptance that the provider office as a cost effective alternative.
- Payor acceptance that qualified devices should be reimbursed.
|
| 5 |
Claim amount published |
Get the claim amount into a published database. |
| 4 |
Establish claim |
Establish the claim amount (the value assigned to a code as a guide for payers), i.e. RBRVS and RVP. |
| 3 |
Obtain temporary code |
There are various types of temporary codes, such as CPT III and regional Medicare HCPCS code. Obtain a code that will be recognized electronically. This starts the grass roots movement required to get national recognition. |
| 2 |
Specialty Societies |
Each specialty society will have a tailored presentation made to the societyís coding committee. The purpose is to obtain support for the associationís coding strategy. Similarly, presentations will be made to secure additional medical luminaries (highly respected providers) to support the associationís goal. This includes clinical study analysis. |
| 1 |
Coding analysis |
From a thorough analysis of the current codes and their reimbursement values, USTR will identify how best to start the coding and reimbursement process. |
| 0 |
Clinical Study Structure |
Determine how best to structure clinical studies to generate the type of utilization and economic benefit data required to support a national code. |
