We offer a comprehensive range of legal, regulatory and legislative services, including analyzing regulations, preparing draft legislation and Congressional testimony, analyzing pending legislation, and working with agency officials and Congressional staff to advocate on proposed regulations and complex legislation.

Patient access and appropriate reimbursement depend on addressing four key elements. Each presents challenges for companies introducing new technology into the healthcare marketplace. Our lawyers and specialists work closely with our clients to address each aspect of the Medicare process:

• Coverage: We work with companies and expert advisors to develop compelling clinical and economic rationales, to identify the key decision makers at CMS and Medicare contractors and to prepare the best presentation of the new technology.
• Payment: We work with CMS and Congress to establish payment methodologies and rates that enhance patient access. Both CMS and the Medicare contractors play important roles in setting rates, and the most effective strategies often involve coordination of many stakeholders, including innovator companies, physicians and patient groups.
• Coding: We help clients obtain and use appropriate permanent, temporary, and unlisted HCPCS, CPT and ICD-10 codes to describe new technology. Effective coding must be coordinated with coverage and payment strategies.
• Billing: Our team helps identify billing issues that may arise at multiple sites of care, when legacy Medicare regulations may have unanticipated effects on new business models.

We also provide clients with guidance on health policy legislation and Congressional oversight. The Coverage & Payment team collectively has many years of experience working on health policy legislative and regulatory matters in the Congress and the Executive Branch. Our attorneys and health policy specialists have served in senior strategic decision-making roles at the Department level and as members of Congressional staff. As a result, we are able to bring unique perspectives to our clients and anticipate their individual needs.