When Silence is Golden in MedTech Reimbursement

In sales, that ringing phone or pinging inbox is a thing of beauty. When prospects or customers reach out, it’s usually a good sign—they want to know more, explore the options, or jump into negotiations. If the sales team has a steady stream of incoming calls, they’re doing something right. Inbound calls = interest, engagement, and potential revenue.

On the reimbursement side, though, things are pretty different. When it comes to payer coverage and reimbursement inquiries, silence really is golden. No news means everything is working as planned: the product is appropriately coded, claims are being processed instead of denied or kicked out for manual review, payment rates are favorable and nobody is confused or seeking clarification from insurers. In short, no one is calling to troubleshoot. In the reimbursement world, a quiet phone and an empty inbox are the marks of success.

Achieving this quiet state isn’t easy. It requires understanding both the payer and the provider needs early on and crafting a reimbursement strategy that anticipates potential snags long before the first claim is submitted. Coverage decisions, coding clarity, and payer advocacy strategies are all fine-tuned to ensure everything flows smoothly once the product is out there.

Every Step in Reimbursement Strategy Should Help to Clear the Path, Not Kick Up Dust

In an ideal world, a well-designed reimbursement strategy leads to a situation where coverage, coding, and payment simply “work”—they’re non-issues, like water running smoothly through a well-constructed pipeline. But achieving this isn’t always straightforward, especially when short-term options like temporary pass-through payments or Category III CPT codes present themselves as “solutions.”

Let’s be clear: these measures may check a box in the short run, but are you sure they don't create more hurdles down the line for your particular innovation? Each reimbursement step should aim to resolve potential bottlenecks, not create a situation where, 6-12 months from now, you’re scrambling to navigate the next layer of issues.

Start with the End in Mind

1. Avoid Temporary Fixes that Become Tomorrow’s Problems (Unless You Know Why Tomorrow's Problems are Worth Having)

Take transitional pass-through payments or Category III CPT codes. Yes, technically, these are available for novel technologies and services, and they make for great press releases... but then what? Once they expire or reach their limits, you might be right back at square one, facing the same coding and payment challenges as before. Instead, focus on solutions that contribute to stable coverage and coding outcomes, like setting up evidence frameworks that pave the way for permanent Category I CPT codes or alternative payment methods that offer sustainability. Or if you do secure a transitional pass-through payment, make sure you know what you're going to do to avoid the "payment cliff" that often accompany these short-term special payments.

2. Think Beyond Coding for Coding’s Sake

Every code needs a reason for being there—it should support clinical adoption, streamline claims, and build payer familiarity. If the code exists in isolation or lacks the evidence payers need to justify covering it, it's not solving any problems. Coding decisions should focus on creating payer-friendly pathways, meaning you’re building data and aligning the code with reimbursement models that facilitate automatic payment, rather than frequent denials and resubmissions. All too often, a code specific to your technology makes it easier for a payer to auto-deny... are you planning for that and know what to do in those situations?

3. Anticipate Customer Needs, Not Just Coding Requirements

It’s essential to consider how coding and payment impact your customers—hospitals, physicians, and patients. If coverage and coding decisions are clear and backed by solid evidence, they become routine rather than a special case, allowing providers to focus on patient care without needing workarounds for denied claims. A good strategy answers customer questions before they even arise, with a roadmap that supports straightforward claims and long-term payer adoption. Your early adopters will need to have some of this awareness to push through the initial rocky years, if there's a light at the end of the tunnel.

4. Secure Evidence that Lasts, Not Just for Regulatory Approval

Passing FDA scrutiny is just one part of the journey; payer requirements are a different ballgame. Focus on gathering clinically meaningful data that speaks to payers’ needs, patient outcomes relative to existing care standards, over just device performance data. This evidence not only cements initial coverage but also creates a foundation for broader and more stable reimbursement options that support your customers’ practice.

5. Focus on Milestones that Solve Problems, Not Just Steps

Every decision should be a solution that advances your customers’ ability to integrate your technology seamlessly into their systems. Temporary steps that don’t build on each other create gaps that need filling later. So instead of seeing each step as an isolated hurdle, ensure it addresses the long-term picture, supporting a stable, scalable path forward without any backtracking.

The Bottom Line: Each Step Should Remove Hurdles, Not Create New Ones

Reimbursement success isn’t about how many steps you can line up—it’s about taking the right steps that support long-term payer acceptance and predictable payment flows. By focusing on sustainable choices, you’re ensuring that each stage in the strategy isn’t just a short-term win, but a strategic solution. The goal is not just to “get through” the reimbursement process but to deliberately remove obstacles one by one, freeing your customers to deliver care without friction - that golden silence of streamlined reimbursement!

Nicole Coustier helps medtech founders address U.S. reimbursement issues confidently, hit their milestones, and land their next round of funding. Over the course of 20+ years, she has helped over 100 companies in the medtech industry in their earliest stages to achieve widespread reimbursement coverage in the U.S.,paving the way to acquisition or IPO.

Let's have a discussion about what you're currently working on, maybe I can help. [email protected] | calendly.com/nicolecoustier/consult