Reimbursement can be separated into the processes of coding, coverage, and payment for medical procedures, products, and drugs.
Coding is the standardized "language" that medical providers of services use to communicate with payers (private insurance, governmental insurance, healthcare entitlement programs, etc.) regarding the procedures, drugs, and medical products they have utilized in rendering services to patients.
Coverage refers to the procedures, drugs and medical products that payers consider to be "covered" under a member's health insurance plan and thus available to them as benefits. Payers may consider coverage for services on a case-by-case basis, or they may choose to establish a specific policy for a particular intervention with indications for when it would, or would not be, appropriate. Interventions deemed appropriate by the payer would be covered and eligible for payment, while inappropriate interventions would be non-covered services and thus ineligible for payment.
Payment is the culmination of the overall reimbursement process and results in final payment to the provider for covered services performed. Payment may be determined by the payer as a condition of provider participation in the program (e.g., US Medicare program), it may be established by contract between the payer and the provider, or through any conceivable combination of these methods (e.g., contracted rates set forth via a standardized fee schedule as an appendix to a provider agreement).
Reimbursement at BD
BD actively engages with payers to ensure market access to BD products is not improperly restricted by payer coding, coverage or payment policies. BD works with payers and other associated stakeholders involved within all facets of the reimbursement processes to facilitate adequate coding, coverage and payment for BD products.
Any knowledge of payer policy that inappropriately restricts coding, coverage or payment for a BD product should be communicated with applicable documentation to BD so that an investigation of the situation may be conducted and a mutual resolution pursued. For your convenience, you may communicate reimbursement-related issues via this link: Reimbursement.
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Reimbursement information is available for the following product categories: