Michael K.

McCormack, FACHE
Arlington, Tennessee 38002
mike.k.mccormack@gmail.com

901-310-9826
www.linkedin.com/in/mikekmccormack

DIRECTOR HEALTH ECONOMICS / POLICY AND REIMBURSEMENT

Extensive experience and highly respected expertise in health care reimbursement, health policy,
market access and health economics. Diligently analyzed federal and commercial payer regulations,
policies, processes and issues. Adeptly developed and executed viable, pragmatic solutions.
Consistently achieved key wins that protected provider reimbursement and facilitated market access
for technologies and procedures. Developed and maintained high performance teams and a climate
of best practices. Areas of expertise include:

Health Care Policy and Reimbursement

Policy Analysis and Solution Development
Sales/Marketing/Customer Service
Strategic Planning/Action Plans

Health Care Administration and Management

Project Management
Budget Planning and Compliance
Cross-Functional Team Building

PROFESSIONAL EXPERIENCE
ACCLARENT, INC., a business unit of Johnson & Johnson, Menlo Park, CA

2012 2014

Director, Health Economics and Reimbursement

Developed and implemented reimbursement strategies that ensured appropriate coding, coverage
and payment for Acclarent technologies and related procedures. Developed reimbursement tools for
use by internal and external customers. Provided coding advocacy, oversaw commercial insurance
market access activities, and advocated for appropriate reimbursement for procedures and
technologies from the Centers for Medicare and Medicaid Services (CMS).
Led advocacy efforts to combat CMS proposal to base physician non-facility PE RVUs and
payments on hospital outpatient or ASC payment rates. Activities resulted in the proposal being
rescinded.
Successfully advocated for APC changes, resulting in a 51% payment increase for Acclarentrelated procedures.
Advocated for policy changes with multiple commercial insurance plans leading to increased
access for over 7.5 million people.
MEDTRONIC, INC., Spinal and Biologics Division, Memphis, TN

2002 2012

Director, Health Policy and Reimbursement

2008 2012
Senior Manager, Reimbursement Planning
2004 2008
Manager, Reimbursement Planning
2002 2004
Provided pre-market reimbursement analyses and developed strategies to ensure appropriate
coding, coverage and payment for products/procedures. Provided management of coding support
resources and coding advocacy. Developed reimbursement support materials for both current and
future technologies, and advocated for appropriate reimbursement for spinal procedures and
technologies from the Centers for Medicare and Medicaid Services (CMS).
Conducted the data analysis and completed the application that led to Medtronic receiving the
first Medicare New Technology Add-on Payment for a medical device.
Appointed to the integration team and performed reimbursement-related due diligence for the
$4.2B acquisition of Kyphon, Inc.

Michael K. McCormack

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MEDTRONIC, INC. (Continued)

Advocated for and won approval on several occasions to regroup procedures to more cost
appropriate and better reimbursing MS-DRGs.

Wrote numerous coding proposals that resulted in the establishment of new ICD-9-CM
procedure codes.
Successfully overturned two National Correct Coding Initiative (NCCI) edits that bundled
physician payment for two common spinal procedures, ensuring provider payment for both
services.
Collaborated with two specialty medical societies to put forth a category I CPT code application
for cervical disc arthroplasty, facilitating physician reimbursement for these procedures.

WEST TENNESSEE HEALTHCARE, Jackson, TN

1996 2002

Compliance Officer
1998 - 2002
Oversaw program development and managed ongoing operations. Led efforts to educate and
ensure organization compliance with health care laws and regulations, along with the organization's
ethics culture. Conducted audits to measure compliance with applicable regulations and developed
needed corrective action plans.

Wrote and published an organization-wide Code of Conduct and trained 4,500 employees in
aspects of compliance and ethics, ensuring a thorough understanding and consistent focus on
organizational compliance.

Initiated a review of the Charge Description Masters that resulted in the organization netting an
additional $5-$10M per year in gross revenue plus other benefits in standardization and
reporting.
Developed and implemented new processes that reduced the amount of medical necessity
denials by more than $120K per month.

Implemented new processes for the charging of observation services, reducing the amount of
denials by more than $125K per year and bringing the organization in compliance with
Medicare's requirements.
Developed and implemented new processes, negotiated purchase of new software, and
established reliable billing of claims to Medicare that reduced potential liability for false claim
charges.

Director, Work Partners

1996 - 1998
Drove strategic planning, product and service development, profit and loss responsibility for a
hospital-owned workers compensation managed care organization. Managed the program with a
scope of responsibility that included provider network development, case management, claims
processing, sales, marketing and customer service.
Grew the product to over 10,000 covered employees in 15 months, capturing a 21% market
share for self-funded employers in the region.

Negotiated contracts and reimbursement amounts with providers, building a provider network
that included over 400 physicians practicing in the area.
Served as a key partner in the establishment of a statewide workers' compensation network that
is marketed to employers with multiple locations across the state.

EDUCATION
Master of Health Administration, Georgia State University, Atlanta, GA
Master of Business Administration, Georgia State University, Atlanta, GA
Bachelor of Science, Kinesiology, University of Tennessee, Knoxville, TN