Coding, Coverage and Payment are the cornerstones of reimbursement strategies for medical technology products!
Key Coding Services:
Coding is the numerical or alpha numerical representation of diseases and their corresponding medical treatments.
Why are billing codes important to confirm for new medical technologies?
It is important for manufacturers to confirm the coding strategy for their products to ensure that appropriate codes are available to customers for accurate billing for use of medical technologies and associated procedures after market launch. This will allow Medicare and other health insurance programs to process claims for treatments and services in an orderly and consistent manner and to reimburse accounts and patients appropriately. It may take 1-3 years of effort to obtain a new billing code.
What we can do for you
Our reimbursement team includes certified coders and reimbursement specialists who have several years of experience in:
- Developing coding strategies for breakthrough medical technologies including drugs, devices, biologics, diagnostics, surgical supplies, and procedures. We can identify whether there is an appropriate existing code representing the relevant medical technology and procedures. Based on our research, we also can develop recommendations on whether there is a need to update an existing code.
- Drafting and supporting the application for new billing codes. If a new billing code is necessary, the GIRS team has maintained an almost perfect record for successful coding applications.
- Conducting coding verifications to confirm that existing codes are appropriate for our clients' products.
| Typical coding projects include: | |
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Case examples of successful coding applications
Types of Reimbursement Codes that are Important for Specific Medical Technology Products
| Here is a breakdown of the major reimbursement codes that need to be researched for each category of medical technology products: | ||
| Medical Technology Type | Likely Type of Code | What we can do? |
| Medical Devices | HCPCS Codes for the product and CPT® codes for the associated procedures. Pass through codes if qualifies for pass through status if it qualifies |
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| Surgical Supplies/Wound Dressings | HCPCS codes for the product | |
| Diagnostics/Laboratory Tests | CPT® codes for the testing | |
| Pharmaceuticals, Biologics, Tissue Products | J codes for the product, pass through codes if it qualifies for pass through status, CPT® codes for the associated procedures | |
Coverage and Payment Services
Why is coverage important for medical technologies?
The assignment or confirmation of the appropriate code does not imply that the technology or service will be covered or reimbursed. Third-party payers finance and manage most medical care in the United States. Payer coverage policies have a major impact on product utilization and payment which directly influence market uptake.
What we can do for our clients.
In the post launch phase, payer advocacy swings into high gear and our payer alliance experts work closely with payers to help inform them of the benefits of our client's products. We help the manufacturer to keep proving the case for the requisite technology by providing payer desired data to maintain coverage and payment.
| Core payer alliance and reimbursement services include: | |
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Case examples of successful coverage and payment services
Other services:
Coverage and Payment Services
Outcomes research
Market positioning
Health economics
International reimbursement
Reimbursement team
Areas of expertise/Key technologies