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helping you ensure coverage for your novel medical device

Let us help remove medical device reimbursement barriers on your path to coverage and market adoption.

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With consulting expertise and a partner network in the most prominent markets of the world, NAMSA brings clarity and focused direction to your reimbursement strategy. We understand how to plan for unforeseen reimbursement challenges and help you proactively tackle changing global requirements to achieve market commercialization.

MedTech Sponsors often face challenges when bringing novel technologies to the marketplace. Healthcare payment and medical device reimbursement systems throughout the world are complex and vary widely from one country to another, making it critical to understand potential reimbursement barriers.

As a result of these intricacies, global MedTech organizations sometimes lack the proper context and contacts when distinguishing effective medical device reimbursement and commercialization strategies—that’s where NAMSA’s international team of MedTech reimbursement experts can put their knowledge to work for you.

NAMSA’s team of MedTech reimbursement consultants offers a full continuum of reimbursement services and solutions for new and existing medical technologies. Our teams are experts in all aspects of MedTech reimbursement strategy, including payer relations, medical policy research, coverage advocacy, HCPCS and CPT code analysis/applications, clinical trial coverage and health economic analysis.


MedTech Reimbursement Strategy

NAMSA understands government and private payer coverage and payment policies under the current global health economics environment. As such, our team designs strategies surrounding specific objectives which are targeted toward reimbursement barriers that would otherwise limit broad market adoption of emerging medical technology, including use of clinical and health economics evidence to secure coverage.

NAMSA assists MedTech Sponsors with a global reimbursement strategy to proactively address potential MedTech reimbursement barriers by pursuing:

  • Coding analysis is a vital component of our reimbursement services, involving a detailed examination of the reimbursement codes associated with a particular medical device. Our coding analysis ensures that the medical device is associated with the most relevant and up-to-date codes, maximizing the chances of accurate and timely reimbursement. In addition, it contributes to the successful market access of our clients’ medical devices, fostering a positive environment for product adoption.
  • A Reimbursement Landscape Assessment is a research-based report that identifies possible barriers to appropriate coding, coverage and payment for a specific medical technology. During an assessment, variations in clinical indications for coverage—based on service setting (inpatient vs. outpatient, hospital, clinic, home care)—are identified, as are payer mix and comparable technologies. This critical assessment forms the basis for creating a MedTech reimbursement strategy to achieve product adoption.
  • Medical Director Interviews and Physician Advisory Boards
    NAMSA conducts primary research with existing health plan Medical Directors to evaluate payer reaction to new technologies, either pre-release or prior to final design. The former can help guide the extent of payer relations work that will be required for successful medical policy coverage, while the latter can be used to determine if a new product is perceived as reasonable and necessary before making final product decisions, thereby de-risking the investment.
  • Often, novel medical technologies that are targets for acquisition require Reimbursement Due Diligence for Investors. NAMSA can perform Reimbursement Due Diligence for venture capital companies and other investors to assess market risk for reimbursement prior to investment.
  • Our team of experts will also meet with hospital and finance staff in advance of major new technology to Assess Adoption. This assists hospitals in determining positive or negative projected margins from Medicare and private payers prior to investing in new medical technologies.



Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) Codes provide the pathway for MedTech reimbursement in the U.S., which are often more important than companies wish to acknowledge. HCPCS coding should play an essential role in any MedTech Reimbursement Strategy.

In the U.S., when new HCPCS Level I (CPT) or Level II coding is required, NAMSA successfully guides clients to achieve new codes through the American Medical Association (AMA) CPT™ process or the Centers for Medicare and Medicaid (CMS) HCPCS Workgroup process. We maintain strong relationships with medical societies whose sponsorship is critical to success throughout medical technology adoption. Although it can be a long process, it can catapult a new technology into the payment pipeline.

Health Economics Analysis

Health Economics Analysis has become increasingly important as payers consider evidence of cost, as well as clinical effectiveness, before covering new technology and services. NAMSA works with MedTech companies with varying types of analyses which may be required to demonstrate cost effectiveness and to accelerate favorable medical policy coverage through the following activities:

  • Cost Effectiveness Analysis (CEA): This is used to evaluate the relative cost of new technologies or treatments and is critical to payers when new treatments are more expensive but also more effective.
  • Cost Minimization Analysis: This type of analysis is used when new treatment is less expensive and at least as effective.
  • Budget Impact Model: This is a comprehensive study of third-party payer payments, technology costs and savings that will result from the adoption of the proposed technology.
Medical Policy Research, Coverage Advocacy & Payer Engagement

NAMSA helps you open the doors for coverage by conducting Medical Policy Research, Coverage Advocacy and Payer Engagement to provide insight into the probable coverage status of new and emerging technologies among government and private health insurers around the globe.

Coverage for specific products and services can vary widely among government and commercial insurance companies, independent of the fact that they often administer similar benefits. When medical coverage policies do not cover specific technologies, or they do not exist, NAMSA’s experts will meet with health plan medical policy makers to advocate for change. Using existing cost-effectiveness tools and available clinical evidence as support for coverage adoption, NAMSA will engage with third-party payers to convey your device’s value story.

Coverage Throughout IDE Clinical Trials

Many device manufacturers do not realize that Medicare, as well as some commercial insurers, will cover new devices during a Category B Investigational Device Exemption (IDE) clinical study. We work with Medicare and health insurance providers to set up payment and billing systems for IDE studies to support ongoing provider enrollment within clinical studies.

Product Adoption Support

Do you require payer relations expertise for the long haul? NAMSA’s experts are available globally throughout the product adoption phase.

NAMSA provides payer relations expertise for the long haul by delivering global capabilities and special services throughout the product adoption phase, including ongoing clinical-user support for coding, billing and coverage support.

  • Reimbursement Guides: NAMSA’s global reimbursement experts assist clinical users in providing guidance to hospitals and physicians for proper billing and coding of manufacturer-sponsored products. These guides also assist hospitals and physicians to understand the likely level of payment for the services associated with new technologies, thereby supporting device adoption.
  • FAQs for Payers: We often help Sponsors create a list of frequently asked questions for payers to help communicate key information for use by hospitals and physicians when first billing for new technologies and services; these may be sufficient in many cases to avoid long payment delays.
  • Draft Appeal Letters: Physicians using new technologies to treat patients often hit roadblocks when payers do not understand the technology. NAMSA can draft appeal standardized letters for clients who want to help physicians readily appeal insurance denials.
  • FAQs for Sales Staff: Your sales staff is on the front lines introducing prospective customers to your new product—that’s why it is so important to provide them with fundamental education to accurately pass onto physicians, nurses and hospital administration when promoting your medical technology.



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Reimbursement Opportunities and Challenges : Factors for Success – A NAMSA and Kalms Consulting sponsored Q&A Panel Discussion
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