Applied Policy excels at helping clients understand how Medicare pays for products and services and how to adapt their businesses to changes in Medicare payment policy. Because we are constantly monitoring the Centers for Medicare & Medicaid Services (CMS) for new policies, we also identify CMS policy changes and analyze how they could affect future Medicare payments. Our team has experience working with Medicare Administrative Contractors (MACs) to help providers reduce the rate of unpaid claims and resolve systemic issues resulting in large numbers of denials. We have experience working directly with CMS to resolve issues not solvable through interactions with the MACs. Leveraging new opportunities through the transition to value-based payment, we work with clients to develop concepts and apply for CMS opportunities, such as through the Center for Medicare & Medicaid Innovation.
Medicare payment policy is the bedrock of payment throughout the U.S. healthcare system. Commercial insurers frequently use Medicare payment rates as benchmarks when establishing their own prices. Medicare is also currently in the middle of a transition away from more traditional, fee-for-service payment towards a system based on paying for valuable care and desired outcomes. In the middle of all of this change, Applied Policy stands ready to help you understand the current landscape, consider potential changes, and analyze how they could impact your business strategy.
We also have experience in helping healthcare providers file claims correctly. Our team has worked with providers to identify issues, whether they reside at the provider or Medicare Administrative Contractor (MAC) level. We have earned a reputation as being a reliable source of information that is working to address and solve systemic issues, not game the system. If a problem can’t be solved at the MAC level, we can elevate it to the national CMS office for attention.
Applied Policy also stands ready to help clients capitalize on new opportunities, especially in the space of value-based contracting. Developing a successful proposal to participate in a CMS demonstration project or Center for Medicare and Medicaid Innovation (CMMI) model requires deep understanding of the Agency and its political and career staff. The Applied Policy team has almost 30 years of combined experience as employees within CMS allowing us to navigate inside that organization efficiently. We have helped clients apply for accountable care organizations (ACOs), alternative payment models in the hospice industry, and alternatives to graduate medical education to help address physician shortages. Each proposal is unique and Applied Policy has the experience and creativity to make proposals successful.