To provide current, accurate, relevant, coding, coverage, payment and health care strategy and payment policy information for our clients’ specific needs, creating and transforming complex payment systems into clear and manageable business opportunities.
Denise A. Merlino, CPC, MBA, CNMT is a nationally recognized coding expert. She has expertise in nuclear medicine, medical imaging, critical care, pulmonary, sleep, psychiatry, geriatrics, drug and radiopharmaceutical reimbursement, hospital and physician office payment policy, pharmaceutical marketing and payer relations.
Ms. Merlino has more than 35 years of experience with clinical, administration and health policy issues in hospitals and physician group practices. She is a nuclear medicine technologist and a certified professional coder with hospital and physician group practice healthcare network experience for a variety of medical specialties. She also has extensive administrative experience in finance, strategic planning and project management.
Denise A. Merlino, President
Denise Merlino specializes in developing relationships, education, and other healthcare reimbursement strategies and tactics for medical professional organizations, pharmaceutical, and biotechnology in a variety of the healthcare and technology fields. She advises clients on coding, coverage, payment and health policy issues.
Ms. Merlino has spent 18 years in hospital and physician office, financial, billing, coding, coverage, payment, strategic planning and project management. Ms. Merlino has spent close to four (4) years as an employee in various positions from Professional Relations, Domestic Commercial Development and Payer Marketing for a large pharmaceutical company. Since 2003, when she launched Merlino Healthcare Consulting, she has provided reimbursement guidance for many professional societies, pharmaceutical companies, imaging companies and biotechnology in a variety of capacities from education, to development and implementation of new coding structures as well as new and innovative payment policy initiatives. In a variety of capacities, she has drafted and submitted Healthcare Common Procedure Code System (HCPCS) code applications for temporary and permanent HCPCS Level II codes for diagnostic and therapeutic supplies, drugs (including radiopharmaceuticals, and biologicals) obtaining many new and revised HCPCS level II codes over the past 10 years.
Additionally, Ms. Merlino has served the Professional Societies in many capacities, playing a key role for the past 15 years in shaping the APC design as the SNMMI-Technologist Section representative for the NM APC (Ambulatory Payment Classification) Task Force. She has been an active member of the SNMMI Coding and Reimbursement Committee since 1996. She has worked for Professional Societies as their AMA CPT and RUC staff liaison for 10 years; working on CPT code submissions, Practice Expense and AMA RUC surveys and submissions for a variety of CPT codes. She has provided staff support for Society of Nuclear Medicine and Molecular Imaging (SNMMI), American Society of Nuclear Cardiology (ASNC), American Thoracic Society (ATS), American College of Chest Physicians (ACCP), American Psychiatric Association (APA), the American Geriatrics Society (AGS), the American College of Cardiology (ACC) and the American Society for Blood and Marrow Transplantation (ASBMT) providing monitoring, strategy, preparing and supplying all activities relating to Medicare’s correct coding initiative (CCI) and Medically Unlikely Edits (MUE), the AMA CPT and RUC activities, on many different CPT procedures. She has experience addressing Medicare coverage for procedure and products on many levels, including experience in working and resolving issues with local Medicare contractors. She has been involved since the inception of the concept of the National Oncologic PET Registry (NOPR) in 2005, a model partnership with Medicare Coverage and Analysis Group and Professional Societies development and successful implementation of the Coverage with Evidence Development (CED) program addressing a multitude of design, education and implementation of coding and billing issues since 2003.
In 1993, Denise was appointed by Governor Weld and then Governor Cellucci to the Advisory Commission for Radiologic Technologists for the Commonwealth of Massachusetts. She has been an invited speaker on the topics of Coding, Coverage and Payment, the CPT and RUC process, APC and other general Reimbursement topics to a variety of audiences. Ms. Merlino is a certified Nuclear Medicine Technologist, Fellow of the Society of Nuclear Medicine and Molecular Imaging Technologist Section and Certified Professional Coder, receiving an M.B.A with a concentration of Healthcare Administration from Western New England College.