No two products or companies are the same.  The Reimbursement Group (TRG) works with your team to develop solutions that best serve your specific needs.  We offer our services a la carte — so you can implement exactly what you need, when you need it.

Call Center Operations:

TRG staffs our Call Center with credentialed experts.  Certified medical coders, credentialed nurse case managers, auditors, and charting technicians are  handling the needs of your physician and hospital clients.
We recognize the immediate needs that drive reimbursement calls and we’re prepared to  respond to those needs promptly, efficiently, and professionally.
Your field sales and clinical staff can rely on immediate meaningful support when they are in the field and have reimbursement questions.  Your provider customers will receive accurate, up-to-date information when they need it.

Clinical Services:

TRG provides consulting services related to clinical trial planning, IND, and IDE protocol development to ensure that Payor needs are addressed in these processes.  Services may extend to actual site support and interface with enrollee insurance plans.  Key reimbursement elements should be included in the Health Economics Data Collection process within the Clinical Study.  Additional services include:
  • Development of Health Economics (HEOR) and Quality of Life (QOL) Study or Registry elements
  • Support of provider IDE & IND filing needs with CMS Medicare Administrative Contractors or federal offices
  • Collection and Analysis of Relevant Cost and Reimbursement Variables during Clinical Trials
  • Establishment of Work Comparables and Value Assessments

Case Management Support:

TRG’s Case Management support services are the primary touch point between many medical device manufacturers and their prescribing physician customers.  For that reason alone, it is the perfect venue for a host of opportunities – most importantly, improved efficiency and increased customer loyalty and satisfaction. Our credentialed Nurse Case Managers are experienced in responding to incoming requests for billing and appeal assistance. Our Case Management services include:

  • Pre-Certification, Prior Authorization, and Pre-Determination Services
  • Availability 24/7
  • Collaboration with our Certified Medical Coders for coding clarification and inquiries

TRG professionally delivers on Reimbursement needs to your customers. First time. Every time.

Field Services Management:

TRG can supplement your Field Reimbursement efforts with our expertise and know-how.  By partnering your company’s Reimbursement, Clinical, and/or Sales Teams we can help bridge the gap where deficits exist — interim or as part of your total plan.  Our seasoned professional field support is HIPAA compliant, and knowledgeable in relevant federal mandates such as Stark Law, Safe Harbors, and Anti-trust regulations.  Our support helps to reduce our clients’ overall risk profile. Our services include:

  • Coding and Chart Analysis for New and Existing Products
  • Audit and Claim Reviews (Hospital, Physician, and Clinical Trial Sites)
  • Charge Description Master (CDM) Strategic Planning
  • Development of Reimbursement Guidance Documents (Hospital Inpatient, Outpatient, and Physician Settings)
  • Work with Key Accounts to Provide Reimbursement Support
  • Sales Staff Training and Support Services during Product Launch
  • Surgeon Training Events/Product Training Events
  • Analysis for Investment Funding/Presentation Services
  • Individually Designed Plans based upon Product and Company Needs.

Strategic Reimbursement Planning Services:

TRG provides consulting services in evaluation of your company’s New Technology product position in the market.  We can assist during the pre-clinical trial phase, launch & commercialization or at any point in between.  Let us help ensure appropriate coverage, coding, and reimbursement support is in place in order to ensure patient access to your new product.

  • Services that we offer include:
  • Coverage, Coding, and Payment Reimbursement Assessments
  • Submission of New Coding Applications
  • Product and Service Pricing Analysis
  • Evaluation and Recommendation of Payor Coverage Strategies
  • Product Launch Support

Payor Policy Development:

Whether looking to outsource your Health Policy efforts or preparing a presentation for a New Technology Committee meeting, TRG has the team and experience to meet your needs.

With implementation of the Patient Protection and Affordable Care Act (PPACA), (a.k.a. Obamacare), the responsibilities of providers, patients, and payors have changed.  New processes and requirements have been introduced in virtually every significant program.  TRG can work to ensure that all stakeholders are prepared:

  • New Technology Assessment Committee
  • Professional Society Educational Support & Advocacy
  • Commercial Policy Development
  • CMS Local and National Coverage Determination (LCD & NCD) Process Support
  • Managed Care Contracting
  • Prospective Payor Analysis and Opinions
  • Staff Training