Nimitt is a boutique consulting firm that provides strategic consulting, analysis, and education on health care reimbursement and the factors that drive it. We have specialized expertise in reimbursement for innovative new treatments in the realm of cell and gene therapies.
Clients come to Nimitt for our in-depth experience with payment systems, including rate-setting, coding, compliance, and provider operations. Our clients know that Nimitt’s team will listen intensely, fully explore operational challenges, engage stakeholders in dynamic ways, and help identify—and implement—solutions that work.
Nimitt is a leader in this space due to our long-standing collaboration and deep familiarity with both provider operations and issues that create barriers to patient access. We bring this expertise to advocate for coverage, coding, billing, and reimbursement changes to ensure that therapies—both existing and new—can be successfully brought to patients.
Our long-standing data-driven advocacy efforts have resulted in significant payment policy changes in the cell therapy space, specifically for stem cell transplant and Chimeric Antigen Receptor T cell (CAR-T) therapy. We have also had notable successes updating Medicare’s payment methodologies for surgical and medical procedures (including injections, infusions, and device-intensive procedures) and Part B drugs. Nimitt led the efforts that resulted in new ICD-10 procedure and diagnosis codes and numerous policy changes to CMS’ inpatient, outpatient, and physician fee schedule payment policies to better reflect providers’ real-world experience in delivering care. We are proud to have helped improve coverage and gain new codes that accurately reflect, and appropriately value, innovative medical advancements.
We are focused and committed to understanding our clients’ needs in order to improve patient access and reimbursement, by working to reduce the day-to-day operational burden of our provider clients, while also supporting industry client, professional associations, and payers as they bring new therapies to market.
“Nimitt” means catalyst, renewal, or progress. Our mission is to be a change agent to ensure that providers can care for their patients in the best way possible. Our team does this by working to improve coverage, removing day-to-day operational barriers, and improving reimbursement. We seek to improve the patient journey by increasing collaboration across all health care stakeholders, including providers, payers, industry, and government.
Jugna Shah is a nationally recognized expert in health care policy, who has worked to address the complex challenges of U.S. and international health care systems since 1995. As President, Jugna leads Nimitt’s team of experts who help providers, payers, professional organizations, and industry to not only understand and thrive under existing payment systems, but also to create new models.
Jugna applies her in-depth expertise in payment systems and provider operations to identify novel policy solutions to improve hospital reimbursement. She has had notable successes in in oncology and stem cell transplant reimbursement improvements. She led a multi-organization advocacy effort that successfully secured coverage for novel cell therapy, obtained new CPT and ICD-10 codes, and revised payment policies for innovative technologies to accurately reflect medical advancements and value them appropriately.
Jugna is also an international authority on designing and implementing case-mix based financing systems throughout Central and Eastern Europe. She is the former Vice President of Patient Classification Systems International (PCSI), the leading international organization on case-mix systems. She is an advisory board member for the National Association of Healthcare Revenue Integrity (NAHRI). Jugna has led numerous technical assistance initiatives through the World Bank, the World Health Organization, and US Agency for International Development to help foreign governments change (and improve) their health care financing systems.
Prior to founding Nimitt Consulting in 2000, Jugna was a Senior Manager with KPMG’s Assurance-Based Advisory Services Practice and an Ambulatory Care Product Marketing Manager at 3M Health Information Systems. Her knowledge of Medicare regulations and policies is honed by long experience: she has been engaged and involved with Medicare’s Diagnosis-Related Groups (DRGs) for her entire professional career and was part of the team involved in creating what became Medicare’s Outpatient Prospective Payment System (OPPS), first implemented in 2000.
Jugna is a passionate advocate who applies her tactical and strategic problem-solving skills to improve health care delivery and access. A dynamic educator, Jugna thrives on helping clients understand complex and often arcane policies on coding, billing, coverage, and reimbursement. Her unique, non-nonsense style challenges and inspires clients—including executives who need the 30,000-foot perspective, and front-line staff implementing policies at the 1,000-foot level. Jugna is a popular speaker who regularly presents to provider and industry audiences on a wide range of topics, including at conferences coordinated by the American Society for Transplantation and Cellular Therapy (ASTCT), American Health Lawyers Association (AHLA), Transplant Financial Coordinators Association (TFCA), HCPro, Healthcare Financial Management Association (HFMA), American Health Information Management Association (AHIMA), and others.
Since 1983, Valerie A. Rinkle has used her expertise to advise clients on federal reimbursement systems, hospital finance and operations, compliance, and data analytics.
Valerie leads Nimitt’s strategic management projects to ensure provider and industry clients alike receive complete and compliant reimbursement. Her encyclopedic knowledge of the constantly changing regulations for providers is unparalleled in the field and was especially valuable for our health care clients in their response to the COVID-19 pandemic. Valerie uses data analytics to assess the most appropriate reimbursement strategy for services and products—including coding, new technology, and pass-through payment applications. She also leads Nimitt’s provider review process—an intensive educational series designed to ensure that hospitals achieve appropriate and compliant reimbursement for SCT and CAR-T services.
In addition to her deep experience with provider operations, Valerie advises device, drug, and cellular therapy companies on market access and reimbursement strategies for new products, including novel therapies.
Valerie also has developed defense strategies for Office of the Inspector General, Dept. of Justice, Recovery Audit Contractors, state Medicaid, and commercial payer audits. She has also served as an expert witness in litigation.
Prior to joining Nimitt as a Principal in 2015, Valerie served as a health care system revenue cycle director for 10 years, and a consultant for Navigant, Certus, Medical Reimbursement Advisors (MRA), and Health Revenue Assurance Associates (HRAA). She previously held leadership positions at the U.S. Dept. of Health and Human Services, including with the Assistant Secretary for Management and Budget (ASMB), Assistant Secretary for Planning and Evaluation (ASPE), and CMS (previously HCFA).
Valerie thrives on managing complicated projects aimed at improved patient access, regulatory compliance, and optimal reimbursement. She has a 360-degree perspective, stemming from having held positions in all aspects of health care: drafting payer rules and policies as a federal employee; implementing operational and financial requirements as a provider; and now advising provider and industry clients on these issues and how to bring new therapies to patients in a financially solvent manner.
Valerie is a popular and frequent presenter at national conferences, including the American Health Lawyers Association’s Institute of Medicare and Medicaid (MMI), Tandem, and HCPro’s Revenue Integrity Symposium (RIS). She also writes and presents on numerous reimbursement and regulatory issues affecting both providers and industry clients. She is an advisory board member for the National Association of Healthcare Revenue Integrity (NAHRI).
Since 2004, Stephanie Farnia has developed strategic solutions to complex health care reimbursement and access issues across the payer and provider continuum.
Stephanie brings extensive expertise in stem cell, cellular, and gene therapy reimbursement and access. She applies her knowledge about commercial payers’ perspectives to help market access teams strategize and implement plans for product launch and address research findings, appropriate reimbursement, and valuation. Stephanie believes deeply in the power of teamwork; a connecter at heart, she fosters collaboration across diverse stakeholder groups to advance health policy.
Before joining Nimitt, Stephanie served as the inaugural Director of Gene Therapy and Cellular Immunotherapy for the Blue Cross Blue Shield Association (BCBSA). In this role, she provided strategic leadership and direction on Advanced Therapies to the BCBS companies, including clinical pipeline tracking, developing network strategies, evaluating value-based payment models, and strategically engaging with external stakeholders. As many of the initial Advanced Therapies are currently focused on rare or ultra-rare diseases, Stephanie spent significant amounts of time understanding how commercial plans, national employer groups and professional provider societies view the rare disease diagnostic journey and treatment landscape.
Previously, Stephanie held policy leadership positions at the National Marrow Donor Program/Be The Match and the American Society of Transplantation and Cellular Therapy (ASTCT). In these roles, Stephanie led efforts to expand Medicare coverage for hematopoietic stem cell transplant and dramatically improve Medicare payment rates for stem cell transplant. Stephanie thrives on the unique reimbursement issues that come with medical innovation and is well-known for sorting through ambiguous and competing agendas to set a clear path for success.
Stephanie is a frequently requested speaker and panelist at national health policy conferences and has authored multiple publications on market access challenges associated with innovative technologies, reimbursement variations for stem cell transplantation, and value-based performance measures. In 2021, Stephanie received the University of Minnesota School of Public Health’s Alumni Innovator Award, in recognition of her innovative and outstanding work in the area of cell and gene therapy.
Since 2012, Amy Rinkle has applied her analytic and operational skillset to expand productivity, reduce errors, improve data quality, and help small and mid-sized organizations grow sustainably.
Amy is adept at interpreting federal regulations and assessing the coding and reimbursement implications for novel breakthrough therapies—particularly for innovative cellular therapies like Chimeric Antigen Receptor T-cell (CAR-T) therapy. She is proficient at analyzing payment implications, return on investment, and the impact of federal policies on client’s commercialization plans. Her deep understanding of the issues enables her to clearly communicate their relevance to Nimitt’s provider, association, and industry clients.
Amy also analyzes the impact of federal payment models and systems on Nimitt’s clients—including IPPS, OPPS, the Quality Payment Program (QPP), Merit-based Incentive Payment System (MIPS), the Radiation Oncology payment model, and drug pricing proposals. She also leverages Medicare claims data, where useful, to understand the impact of regulatory changes on hospitals and physicians.
Amy writes and edits coding and billing guides for Nimitt’s clients that produce novel cell and gene therapy products, in order to improve the utility of customer-facing materials’ to end users, and to complement product launch strategies. She is the developer of Nimitt’s proprietary Coding & Reimbursement Roadmap educational framework. These roadmaps help Nimitt’s industry clients understand the relevant coding and reimbursement workstreams that must be accomplished in alignment with their product’s anticipated launch date and helps them to facilitate and coordinate all necessary activity and deadlines.
Before joining Nimitt in 2017, Amy worked in purchasing and as a data support specialist for a large independent audiobook publisher. She also served as a business development manager for a tech start-up located in Amman, Jordan, applying her background in Middle East Studies and Arabic. In these roles, Amy specialized in process flow documentation and optimizations.
Since 2018, Kristen Muncy has worked extensively in Stem Cell Transplant (SCT), Solid Organ Transplant, Chimeric Antigen Receptor T-cell therapy (CAR-T), and Cellular Therapy. Kristen is a highly capable leader with a deep understanding of revenue cycle, provider operations, and managed care contracting. Her unique and comprehensive perspective helps providers take their solid organ, SCT, and cell therapy programs to the next level, and helps market access understand how providers onboard new therapies. Recognizing that health care is only as good as the system that delivers it, Kristen applies her skills to reduce provider burden, optimize reimbursement, and expand patient access in a sustainable way.
Before joining Nimitt in 2023, Kristen was the Lead Transplant Contract Manager at one of the largest, most experienced transplant centers in the Southeast. She supported efforts to provide patients with high-quality clinical services while maximizing reimbursement. Kristen successfully led numerous multi-million-dollar, multi-year commercial and governmental contract negotiations for high-volume Solid Organ Transplant, Stem Cell Transplant (SCT), and Cellular Therapy programs. Her previous efforts have resulted in multi-million dollar improvements in registration and charge reconciliation, significant growth in cellular therapy, and a successful triennial accreditation with FACT.
Kristen is committed to expanding patient access and thrives on developing solutions to ensure providers have the operational and financial resources needed to deliver innovative and life-saving treatments. She leverages her strong data analytics skills and extensive background in provider operations and revenue cycle to create reliable and efficient transplant financial models; optimize and operationalize payer contracts; and resolve million-dollar, multi-faceted claims issues.
Kristen started her career at the Baptist Women’s and Children’s Hospital and Hewlett Packard Enterprise, where she gained valuable experience in project management, marketing, and human resources.
Kristen has wide-ranging experience contracting for complex and costly services, managing quality initiatives, onboarding new cell therapies, managing relationships with industry leaders, solving multi-faceted operational problems, creating and executing strategic plans, and leading complicated revenue cycle optimization projects. These successes undoubtedly stem from her exceptional listening skills, genuine interest in people, and ability to inspire others to work together for the greater good. An active member of numerous nonprofits, she is dedicated to serving others and to making a positive impact on the community.
Susan K. Flinn has more than 25 years of public health experience in program coordination, including writing, editing, research, and meeting management.
Susan helps Nimitt work with clients effectively and efficiently. She supports the organization with writing and editing activities, coordinating meetings and work schedules, and providing on-site and remote oversight of client work flow. Prior to joining Nimitt in 2000, Susan was a Federal lobbyist for a adolescent reproductive health organization; a research assistant for a National Institutes of Mental Health (NIMH) study on the biological effects of sexual abuse; and a state organizer for reproductive rights.
Susan is adept at bringing order out of chaos, and helping clients increase their productivity. The author of numerous publications, Susan is known for creating content that is accessible to providers, policymakers, and the general public. Her work has been published by Federal agencies, advocacy organizations, and public health associations. She is also an accomplished editor who works with non-profit and for-profit organizations to organize and enhance their communications.