Reimbursement is an increasingly important consideration in the development and marketing of medical devices and BARD recognizes its critical importance to the customers who use our products.
As the largest single healthcare insurer in the U.S., Medicare has a profound influence on the healthcare market. The Centers for Medicare and Medicaid Services (CMS) formulates national and local coverage policy and sets reimbursement rates for facility and physician providers. As for commercial payers, managed care organizations cover approximately 200 million individuals in the U.S. and these payers often follow the lead set by CMS when determining their own coverage and payment guidelines.
Regardless of the payer, three basic steps must occur for the product or procedure to be considered reimbursable.
- First, payers must consider the product or procedure as a part of a covered set of benefits
- Second, a billing code must exist or be established to identify the product or procedure
- Finally, payment must be assigned for the code
In general, the complexity and integration of these processes are significant challenges for manufacturers seeking to bring products to market. BARD's Corporate Reimbursement Department seeks to work with decision-makers including government agencies, specialty medical societies and public and private payers to ensure our products are appropriately reimbursed in the marketplace.
For many BARD products, considerations necessary to establish reimbursement are already established as their use falls under existing categories of care such as those for inpatient hospital services or outpatient and ambulatory care settings. Under such systems, a prospective payment bundle (DRG or APC) is set to include costs of services and products needed to provide a specific procedure or episode of care. BARD continually monitors the sufficiency of these reimbursements and takes actions to insure they are adequate and appropriate.
Important: C. R. Bard, Inc does not guarantee that Medicare or any public or private payer will cover any products or services at any particular level and specifically excludes any representation or warranty relating to reimbursement. Laws, regulations, and payer policies concerning reimbursement are complex and change frequently, and service providers are responsible for all decisions relating to coding and reimbursement submissions. Accordingly, C. R. Bard, Inc. strongly recommends that you consult with your payers, reimbursement specialist and/or legal counsel regarding coding, coverage and payment matters.