Biomedicine
Healthcare system in USA
The health care system in the United States of America is a well established and structured system that aims at offering services to American citizens for the treatment and prevention of diseases, further more the system also seeks to promote mental and physical well being of its citizens. On a broader perspective the health care system in the U.S.A. can be defined as system concerned with where and how medical services are offered to America's citizens, secondly the system is concerned with medical expense and who pays for this and thirdly who offers these medical care services, for example, nurses, specialist physicians or primary care physicians.
Importance of knowing how to prepare healthcare system in the U.S.A.
The preparation of the healthcare system in the U.S.A. is a critical issue in the country because it is this system that's responsible for improving the overall health sector of the country, ensures good health to the Americans, provides affordable medical care and also the system is responsible for meeting the expectation of Americans in terms of health requirement and standards.
Distribution and payment flow for biomedical products
The distribution of biomedical products that are self administered is done through pharmacies who act as middlemen between biomedical wholesalers and patient, and the payment flow is through the patients to the retail outlets that include hospitals and pharmacies, from the retail outlet the payments get channeled to...
Important to note about this distribution and payment flow is that pharmacies collects payments which are then given to insurance companies so as to get reimbursement for the biomedical product.
Another example of distribution and payment flow for biomedical products is the distribution of products to the patients through physician's office or hospital outpatient or inpatient; here payment is form the wholesaler to the biomedical product manufacturer.
Reimbursement planning activities
Reimbursement for products and services in the U.S. healthcare system consist of payment for supplies and services to the health facility and the payment for services provided by the physician, at times the reimbursement include payment for new products that will improve clinical services. Planning activities for reimbursement mostly commence at the
product development stage when market assessment is being conducted, in this stage the three pillar of reimbursement that include coding, coverage and payment are addressed and a company can either seek assistance from reimbursement and regulatory experts or hire a professional reimbursement personnel who can be charged with responsibility of reimbursement planning activities. The planning activities first consider the targeted patient population and then develop strategy on how they can be reimbursed.
Reimbursement planning activities and pathway for in vitro diagnostics (IVDs)
The reimbursement planning activities for IVDs is similar to those of devices and infused drugs, whereby hospitals, laboratory services, physician's offices among other health providers who are primary purchasers of IVDs and reimbursement claims are made using code CPT or procedure code ICD-9. IVDs manufactures engage in reimbursement planning activities that includes; gathering relevant clinical data; collaborating with CMS groups to obtain coverage; Asses private payers so as to determine coverage cost; Identify applicable procedure codes; Identify the category for Medicare benefit; submit application for reimbursement and coverage level determination; await the
determination done by either gap fill or cross-walk method and lastly work jointly with other payers of the…
