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022 – Tom Hughes
Neurotech, Neurotech Podcast

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

  1. The three legs of the reimbursement stool are coding, coverage, and payment.
  2. When figuring out reimbursement, it’s important to consider details like the site of care.
  3. Obtaining reimbursement requires showing evidence that your device is medically necessary.

Show Notes

  • [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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