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Welcome to Global Integrated Reimbursement Services’ blog. The purpose of our blog is to allow access to a repository of issues that our company tracks regarding the reimbursement for pharmaceuticals, medical devices, diagnostics, biologics, and biosimilars. Also, it shows you how we can assist you in these areas.

Medicare Part B Policy Change for Discarded Drugs and Biologics for 2017

Posted by on Dec 12, 2016 in Coding & Billing | Comments Off on Medicare Part B Policy Change for Discarded Drugs and Biologics for 2017

  In addition to paying for the amount of drug that has been administered to a Medicare patient/beneficiary, Medicare Part B also reimburses the amount of discarded drug, up to the amount on the package label. The discarded drug amount is the amount of a single use vial or other single use package that remains after administering a dose/quantity of the drug to a Medicare beneficiary. Effective Jan. 1, 2017, the Center for Medicare and Medicaid Services (CMS) will require uniform use of the JW modifier for Part B drugs or biologicals from single use vials or single use packages.   Under this policy change, providers and suppliers will be required to: Use the JW modifier when submitting Part B claims for discarded drug or biological amount not administered to any patient, except for Competitive Acquisition Program (CAP) drugs and...

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GIRS Educates Clients about Coding Changes and Reimbursement for Pneumatic Compression Devices

Posted by on Oct 7, 2016 in Coding & Billing | Comments Off on GIRS Educates Clients about Coding Changes and Reimbursement for Pneumatic Compression Devices

The original article “Correct Coding for Pneumatic Compression Devices” was published in August 2010. The Durable Medical Equipment Pricing Data Analysis and Coding (PDAC) contractor announced today that this article was revised recently. This revision provides additional information regarding the HCPCS coding requirements for PCDs and related appliances. It also emphasizes that the only products that may be billed to the DME MACs using codes E0650, E0651, E0652, and E0675 are those for which the PDAC has completed a Coding Verification Review. Please contact GIRS to obtain information on the coding changes for the PCD and related appliances. If your device has not been reviewed by the PDAC, please contact GIRS for assistance to submit a Coding Verification Review. The PDAC review is important for Medicare coverage and payment as well as for other payers like Medicaid and commercial...

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GIRS Provides Road Maps of Successful Marketing and Reimbursement Strategies

Posted by on Jul 26, 2016 in Coding & Billing | Comments Off on GIRS Provides Road Maps of Successful Marketing and Reimbursement Strategies

GIRS Provides Road Maps of Successful Marketing and Reimbursement Strategies… Recently GIRS completed several Landscape Assessments to help our clients develop the foundation for their marketing, clinical outcomes, and reimbursement strategies. Some typical impactful outcomes are: GIRS researched the key payer markets and providers to determine the medical device coding, coverage, and reimbursement implications and provider perspectives of two implants being packaged with surgical instruments or provided separately. This helped our client to decide how best to package their medical device implants to meet the needs of the providers as well as insurers. GIRS researched the Medicare National Non Coverage for a Biologic Product as well as Commercial Payer and Workers’ Compensation coding, coverage, payment and clinical outcomes requirements in each payer market. The resulting innovative payer strategies are being implemented now for each key payer market. GIRS researched...

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2014 Landscape Assessment and Coding Strategies: Provided Effective Coding Strategies of a Device for Gastroenterology Supply Reimbursement

Posted by on Oct 16, 2014 in Coding & Billing | Comments Off on 2014 Landscape Assessment and Coding Strategies: Provided Effective Coding Strategies of a Device for Gastroenterology Supply Reimbursement

Global Integrated Reimbursement Services Inc. (GIRS) got a referral from a former contractor because they considered us to be “the best in the business.”  The company had two Randomized Control Trials (RCTs) that were being conducted but could not find any existing HCPCS code for the device.  The client needed a high level Reimbursement Landscape Assessment that focused on coding and reimbursement strategies to be completed in two weeks to present to investors.  We reviewed the Product information and worked with our certified coders to review several coding categories and other similar devices and authoritative guidance. Our payer policy team reviewed payer coverage policies and regulations and consulted with the key payers.  The end result was a comprehensive set of short term and long term coding and reimbursement strategies.  The client was very pleased with the results and sent...

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