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 a special 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 the issues that create barriers to patient access.  We bring this expertise to advocate for coding, billing, and reimbursement changes so that new policies and new codes benefit our provider and industry clients. Our long-standing data-driven advocacy efforts have resulted in significant payment policy changes for Chimeric Antigen Receptor T cell (CAR-T) therapy; updates to Medicare’s payment methodologies for surgical and medical procedures (including injections, infusions, and device-intensive procedures); new ICD-10 procedure and diagnosis codes; and numerous adjustments to CMS’ inpatient, outpatient, and physician fee schedule payment policies to better reflect providers’ real-world experience in delivering care.

We are intensely focused and committed to understanding our clients’ needs in order to improve patient access, reduce provider burden, improve reimbursement, and support both industry and payers as they bring new therapies to market.

“Nimitt” means catalystrenewal, or progress. Our mission is to be a change agent to improve the health care system and our clients’ operational processes—with positive results for providers, payers, industry and, most importantly, the patients for whom they care.

 

Jugna Shah, MPH, CHRI, President & Founder

Jugna Shah is a nationally recognized expert in health care policy, with more than 25 years of experience addressing the complex challenges of U.S. and international health care systems. 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 effective reimbursement strategies. She has had notable successes in in oncology and stem cell transplant reimbursement improvements. Most recently, 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. 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 TCT (Transplantation & Cellular Therapy Meetings), AHLA (American Health Lawyers Association), TFCA (Transplant Financial Coordinators Association), HCPro, HFMA (Healthcare Financial Management Association), AHIMA (American Health Information Management Association), and others.


EXPERT PARTNERS:


Valerie A. Rinkle, MPA, CHRI, Principal

Valerie A. Rinkle has more than 35 years of expertise in advising 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 is especially critical as health care responds 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. 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 experience supporting mergers and acquisitions and analyzing defense strategies associated with Office of the Inspector General, Dept. of Justice, Recovery Audit Contractors, state Medicaid, and other audit agencies. She has also served as an expert witness in litigation associated with such audits.

Prior to joining Nimitt as a Principal in 2016, Valerie served as a health care system revenue cycle director for 10 years, and a consultant for Navigant Health Revenue Assurance Associates. 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 revenue cycle optimization projects, ands ensuring patient access, regulatory compliance, adequate reimbursement, and back office enhancements. 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.. She is a popular and frequent presenter at national conferences, including the American Health Lawyers Association’s Institute of Medicare and Medicaid (MMI), TCT | Transplantation & Cellular Therapy Meetings, and HCPro’s Revenue Integrity Symposium (RIS). She also writes and presents on numerous reimbursement and regulatory issues affecting both providers and industry clients.


Stephanie Farnia, MPH, Principal

Stephanie Farnia has more than 15 years of experience developing 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. In her role, Stephanie acquired a deep understanding of the clinical and financial decision-making processes involved with the evaluation and implementation of coverage policies for Advanced Therapies.

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, previously the American Society for Blood and Marrow Transplant).  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. She 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. 


Susan K. Flinn, MA, Business Analyst

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.


Amy Rinkle, Senior Research & Policy Analyst

Amy Rinkle has more than 5 years of experience analyzing provider claims data and Medicare payment systems. She is adept at interpreting and commenting on federal regulations with coding and reimbursement implications for novel breakthrough therapies, including innovative cellular therapies like Chimeric Antigen Receptor T cell (CAR-T) therapy.

She also analyzes federal payment models—including the Quality Payment Program (QPP), Merit-based Incentive Payment System (MIPS), the new Radiation Oncology payment model, and drug pricing proposals—to assess their impact on Nimitt’s provider and industry clients.

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, due to her background in Middle East Studies and Arabic.

In these roles, Amy applied her analytic skills and operational expertise to expand productivity, reduce errors, improve data quality, and help organizations grow sustainably.

Amy specializes in process flow documentation and optimizations. Her data analytic skills and knowledge of payment system design enabled her to identify problems in Medicare’s own payment calculation for the new CAR-T MS-DRG 018, and recommend a correction to the agency. She is extremely proficient at analyzing payment implications, return on investment, and the impact of federal policies on client’s commercialization plans.