Fact Or Fiction
Reimbursement is the ultimate responsibility of the Manufacturer or Distributor…
FACT: Reimbursement is the responsibility of the manufacturer and the distributors not the end users. Leaving reimbursement to be established by end users will assuredly minimize utilization and erode the procedures value.
I have a permanent CPT Code, Payers will have to pay for this now…
FICTION: Permanent CPT Codes does not mean payers will issue a positive coverage decision for the medical device or technology. Coverage decisions after coding require the assistance of a reimbursement expert.
I have “T” code, Payers will have to pay for this now…
FICTION: Temporary CPT Code assignments do not guarantee medical acceptance or reimbursement from payers. Often times the “T” codes are not even recognized by payers. Payer coverage requires the assistance of a reimbursement expert.
Medicare is providing coverage; all payers must provide coverage now too…
FICTION: Third party payers may use Medicare coverage decisions as a guideline for their medical policies. It is not mandatory that third party payers follow Medicare guidelines.
Clinical Trial reimbursement is where the process should begin…
FACT: The reimbursement strategy advantage starts with clinical trials. Whether your technology is in trials, just received FDA approval or you have been marketing it in the United States for some time, it’s never too late to create and implement a winning reimbursement solution!
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