Nimitt helps providers across the nation optimize operational, financial, and revenue cycle processes and understand the associated reimbursement implications of both government and commercial payment methods. Our deep understanding of provider operations – combined with our advocacy and payment policy successes – uniquely positions us to address a large range of topics.

  • A comprehensive “Provider Review” (most popular provider offering) that includes didactic educational sessions, case reviews, and 12 work group meetings that culminate in operational and financial process improvement recommendations. Reviews focus on:
    • Stem cell transplant / bone marrow transplant (SCT / BMT)
    • Chimeric Antigen Receptor T-Cell (CAR-T) therapies and 
    • Other novel cell and gene therapies
  • Charge Description Master (CDM) set-up and review to ensure compliant and defensible pricing with a focus on high-cost novel therapies
  • Claims data analysis to identify revenue opportunities and coding and billing errors
  • Cost report preparation support for SCT and CAR-T services, focused on providing education on specific CMS instructions and how to interpret and implement them
  • In-depth education and training on a wide range of coding, billing, and reimbursement topics
    • In-depth education on accurate coding, billing, and reimbursement for SCT, CAR-T, and other novel cellular therapies
    • Implementing annual CMS payment system rule changes (IPPS, OPPS, MPFS)
    • Decoding coverage policies and Medicare Transmittal guidance
    • Drug administration coding and billing
    • Clinical trials billing
    • Patient status and observation services
    • Care management services such as Social Determinants of Health (SDOH) assessments, Principal Illness Navigation (PIN), Community Health Integration (CHI)
    • Managing and appealing claim denials
    • Other tailored training sessions upon request
  • Managed care guidance and support for contracting
    • Detailed assessment of contract language
    • Education on implications of existing language and insights into best practices 
    • Review of global packets for payment accuracy against contract terms
    • On-call assistance to negotiate optimal managed care agreements
  • Medical record reviews to ensure contents support accurate coverage, coding and billing in a variety of clinical areas: 
    • Cell and gene therapies
    • Drug administration/injections and infusions
    • E/M visit coding
    • Drug and biologicals billing
    • Others upon request
  • Provider roundtable advocacy initiative
  • Real-time problem solving and on-call technical assistance on provider focused operational and financial questions