022 – Tom Hughes
Tom Hughes is the Senior Principal Advisor in Healthcare Economics and Reimbursement at Regulatory and Clinical Research Institute, Inc. He holds a J.D. from William Mitchell College of Law, and an undergraduate degree from the University of Minnesota-Twin Cities.
Top 3 Takeaways
- The three legs of the reimbursement stool are coding, coverage, and payment.
- When figuring out reimbursement, it’s important to consider details like the site of care.
- Obtaining reimbursement requires showing evidence that your device is medically necessary.
- [1:20] Tom’s winding background.
- [3:00] What is reimbursement?
- [5:10] Tom’s process for introducing a company to reimbursement consulting.
- [7:40] What happens if there isn’t a code for a new device?
- [9:00] Evidence development.
- [9:47] Reimbursement evidence vs. clinical trial evidence.
- [11:10] How to demonstrate medical necessity.
- [12:15] Where are startups weakest regarding reimbursement?
- [14:00] The integration of regulatory and reimbursement.
- [15:20] When to begin thinking about reimbursement.
- [16:45] Payment vs. coding.
- [19:30] Cash pay.
- [20:50] Biggest reimbursement mistakes companies make.
- [21:10] You should figure out what payor think.
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