Coverage & Reimbursement

MDMA works with the Centers for Medicare and Medicaid Services (CMS), Congress and various other stakeholders to ensure that medical technologies and devices receive appropriate and adequate reimbursement. Recent comments have included Coverage with Evidence Development (CED), annual fiscal year Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) drafts and much more. Advocacy efforts include CPT coding reform, ICD-10 implementation, ensuring patient access to innovative and novel products and more.

Coding Reform

As medical devices and techniques evolve, a critical element of patients' access to the latest, most innovative procedures is a transparent and predictable provider reimbursement process. This often begins with medical coding that is free from misinterpretation or controversy. Unfortunately, there is a growing number of examples where existing coding may provide a disincentive for newer technologies to enter the market. In some cases, professional organizations may not formally raise known issues with current codes to relevant authorities. To foster better patient care and innovation, codes should be reviewed regularly to consider revisions to their descriptions and valuation.

The MDMA Coverage & Reimbursement Working Group typically meets on the 2nd Wednesday of each month at 2pm ET via teleconference. If you would like to join this working group, click here.

Latest News

MDMA Submits PFS and OPPS Comments to CMS

MDMA submitted comments today for the proposed revisions under the Medicare Physician Fee...

Senate Introduces Bill to Streamline Breakthrough Technologies

Medicare Payment Advisory Commission (MedPAC) Releases March 2016 Report to Congress

Today the Medicare Payment Advisory Commission (MedPAC) released its March 2016 Report to Congress...

CMS Releases FY 16 Hospital Value-based Purchasing Program Results

The Centers for Medicare and Medicaid (CMS) today released the Hospital Value-based...

CMS Releases New Utilization & Payment Data for Medical Equipment & Supplies

As part of their ongoing efforts to provide greater transparency around Medicare data...

ICD-10 System Now Live

The US health care system has officially transitioned to the...

MDMA Submits Comments to CMS on OPPS

MDMA submitted comments to CMS this week on issues impacting patient access...

MDMA Statement on 21st Century Cures Discussion Draft

MDMA issued the following statement today in response to the latest "21st Century Cures" discussion draft...

House of Representatives Overwhelmingly Passes SGR Repeal Legislation 

The House of Representatives today voted by an overwhelming number of 392-37 to pass H.R. 2, the "Medicare Access and CHIP Reauthorization Act of 2015."

MDMA Statement on 21st Century Cures Discussion Draft

MDMA FY 2014 OPPS Final Rule Summary

MDMA PFS CY 2014 Final Rule Summary

US District Court Decision on Device Tax (Manufacturer vs. Distributor)

MDMA Raises Concerns About Proposed Changes to IDE Process

MDMA recently filed comments on the CY 2014 proposed rules for the Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS).  MDMA noted that CMS’ revision...

MDMA Submits Comments on CMS's FY 2014 IPPS Proposed Rule

MDMA submitted comments today to the Centers for Medicare and Medicaid Services (CMS) for the FY2014 proposed rule for the Inpatient Prospective Payment System (IPPS)

MDMA Submits Comments on Coverage with Evidence Development Draft Guidance

MDMA submitted comments this week to the Centers for Medicare and Medicaid Services (CMS) regarding their draft guidance for Coverage with Evidence Development (CED)…..