Coverage Analysis

“It’s the collaboration with our clients that enables our experts to create the most thorough coverage analysis.”

Alex Morillo
Director, Coverage Analysis Program

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Figuring out what procedures can be reimbursed by Medicare or third parties is complicated. Our experts interpret study protocols and clearly communicate the coverage analysis findings so clients understand billing requirements.

Expert Analysts
Our team provides detailed coverage analyses for clinical trials in all therapeutic areas including oncology and medical devices. They understand study protocol review, standard of care practices, insurance programs, National Coverage Determinations (NCD), and the complexities of Local Coverage Determinations (LCD).

Complete Billing Plans and Grids
The billing plans we create based on our coverage analysis include applicable NCDs, related national guidelines, and journal references to distinguish between routine procedures covered by insurance and sponsor-covered procedures. We also review and include applicable LCDs, which can uncover potential limitations such as understanding which procedures or tests covered in one state may not be covered in another.

Collaborative & Educational Experience
Our Coverage Analysis team members can collaborate with your staff to provide a beneficial educational experience as they work together. They can pass along their knowledge of coverage analysis best practices and how to use strategies like standardized processes and checklists to increase accuracy and efficiency.

Flexible Approach
Over the years, we’ve developed and honed our strategies and processes, but we understand that institutions have their own needs and preferences. We are able and willing to adapt our approach to ensure a positive and efficient working relationship.