Payment & Health Care Delivery Policy
AdvaMed’s Payment & Health Care Delivery Policy department develops and advocates for policies to ensure and expand patient access to medical technologies by improving coverage, coding, and payment processes used by Medicare and, in certain instances, commercial payers.
Food and Drug Administration approval of medical technologies for use in health care delivery is only one step in ensuring that patients have access to life-saving technologies used in a wide-range of medical procedures and services. These technologies and associated services must also be covered by health care plans. As the nation’s largest single insurer, the Medicare program and its coverage and reimbursement policies play a central role in making these technologies available to Medicare beneficiaries and patients generally.
AdvaMed’s Payment & Health Care Policy Department works with Medicare officials to improve coverage and payment policies for the broad array of medical technologies. The Payment Department develops its positions to respond to specific Medicare-related issues that arise through proposed rules issued annually by Medicare for major benefit categories, such as inpatient hospital care and physician services, or in anticipation of issues emerging related to coverage, coding, and reimbursement. AdvaMed’s positions on these topics are shaped by a variety of different work groups organized by Medicare’s benefit categories or broader areas such as digital health technologies, radiation therapy, and diabetes technologies. The Payment Department also undertakes research projects to develop reports on the role and contributions of the medical device industry to the health of patients.
Policy
Medicare Coverage and Payment Policy
As the nation’s single largest health program, Medicare payment policy dictates coverage and reimbursement for over 60 million individuals. Ensuring appropriate Medicare coverage of and reimbursement for medical technologies ensures greater patient access and choice in their care.
Policy
Improving Access to Innovative Technologies
New and innovative technologies often face many hurdles establishing Medicare coverage. An alternative expedited pathway to coverage and payment for these devices and diagnostics would bolster the innovation ecosystem and provide Medicare patients swift access to these technologies.
Diagnostics
Diagnostic Tests Coding, Coverage, and Payment
Diagnostic tests provide vital information in the management and care of patients. Appropriate coding, coverage, and payment policies for diagnostic tests are crucial to ensuring these products and services are accessible to the patients who need them.
Resource
Medtech Value Framework
In today’s environment of stakeholders wanting to slow the rate of growth in national health care spending, it is critical that Medtech developers demonstrate the value of their technologies with sound, empirical data and evidence. AdvaMed’s Medtech Value Framework serves as a resource for members to assess and communicate their evidence and the value of their technologies.
