Reimbursement Blog

kathryn-barry-at-desk-225x300Welcome to KBA’s Reimbursement blog. Our purpose is to provide an educational forum for busy medical device professionals. On a daily basis, we monitor the Federal Register, CMS, AMA, professional society and leading payer websites for announcements about medical device codes, coverage and/or reimbursement changes. When we find something interesting, this forum provides us with an opportunity to share it with our colleagues. Through the years, we’ve learned that knowledge is power! In the coming year, we believe that coding and reimbursement will increasingly impact healthcare provider product purchasing decisions, as well as corporate business development decisions, especially those related to potential acquisitions and investments.

What differentiates us from other reimbursement consultants? We know how to translate policy into practical business solutions. While we enjoy researching health policy, we are known for our ability to anticipate changes and incorporate them into our client’s strategic reimbursement plans. In the area of medical device coding, coverage and reimbursement, what you don’t know can definitely hurt your business. Through this blog, we want to share education and information about the complexities inherent to U.S. healthcare financing and delivery. Consider this a quick “heads-up” on a new development that will soon impact medical device sales and marketing.


The purpose of this memo is to summarize key findings in Medicare’s CY16 PROPOSED Hospital Outpatient Prospective Payment System (HOPPS) rule, as posted on Medicare’s website on July 1, 2015. The anticipated date of publication in the Federal Register is 7/8/2015….

FYI: Please take a moment to skim the attached two headlines in today’s news and feel free to share them with your sales team:  Medical Center of Central Georgia, Macon, Georgia agrees to pay $20-million (Modern Healthcare (4-28-15) for improperly billing short-term…

4/20/2015 – The purpose of this memo is to summarize key points raised in Medicare’s FY16 Inpatient Prospective Payment System (IPPS) proposed rule, as released on 4/17/15 @ www.cms.gov. Please consider this a preliminary assessment pending additional review of the…

Key decisions from Medicare’s FY2015 Hospital Outpatient Prospective Payment System (HOPPS)-Final rule published on www.cms.gov on November 1, 2014 and in the Federal Register on November 10, 2014.  These changes become effective January 1, 2015. General impact: For CY 2015,…

On 10/31/14, Medicare released the CY2015 Physician Fee Schedule (PFS) final rule on its website (www.cms.gov).  This final rule has not yet been published in the Federal Register.  Key decisions include: 2015 Conversion Factor (CF) (page 534): Physician Fee Schedule …

Thousands of pages have been released by Medicare over the past three months regarding proposed and final 2015 payments to physicians, hospitals and free-standing Ambulatory Surgery Centers (ASCs).  For the busy medical device executive, I encourage you to skim this…

The new joint venture recently announced by Anthem and seven prominent Southern California healthcare systems, Vivity, is not good news for medical device companies selling premium priced innovation and/or expensive “commodity” products.  Consider this another shot across the bow, along…

The purpose of this document is to provide a summary of Medicare’s CY2014 Physician Fee Schedule (PFS) Proposed Rule. It was placed on display @ www.cms.gov on July 08, 2013 and will be published in the Federal Register on July…

FY2014 Inpatient Prospective Payment System (IPPS) proposed rule The purpose of this document is to provide you with a practical & brief synopsis of Medicare’s FY2014 IPPS proposed rule, released on 4/26/13 at www.cms.gov. Please call if you would like additional…