Once a HCPCS code is established for a new medical device, biological or drug, the next critical step is ensuring the rates established is accurate and appropriate for the product.
If the product is durable medical equipment, prosthetic, orthotic or supply, then the payment will be provided by a fee schedule. We understand the process that CMS uses in calculating the fee schedules and will work with the manufacturer to ensure that an appropriate fee schedule amount is calculated. Drugs and biologicals are reimbursed differently than medical devices and we work with the clients to ensure that the payment will be appropriate for it.
We help clients to understand the Medicare reimbursement landscape for their product, the fee schedules and the reimbursement methodologies across different sites of service.