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Reimbursement's Straight and NarrowReimbursement's Straight and Narrow

March 1, 2007

2 Min Read
Reimbursement's Straight and Narrow


Because almost every interaction between medical device sales reps and their customers has the potential to violate federal fraud and abuse statutes, government authorities are rightly watchful when it comes to the activities of a company's salespeople.

Far from creating greater opportunities for potential abuse, however, a reimbursement sales model can actually keep medical device companies on the right side of federal healthcare regulations. When implemented correctly, a reimbursement sales process helps to ensure that a company's reimbursement messages to customers are consistent with regard to all ethical, legal, and correct-coding concerns.

One way that this is accomplished is through basic reimbursement training, which ensures that the company's sales force is equipped to answer questions accurately and correctly. The company should support this training through its contracts with professional coding consultants. Such contracts should be designed to ensure that all of the company's informational materials follow correct-coding principles. This should be true whether the materials are used for employee training or for external communications with customers, investors, or others. Proper implementation of these aspects of a reimbursement sales model should reinforce customer understanding that the company's information is limited to correct-coding practices and does not address coding for revenue purposes, which could result in legal actions or fines.

This distinction is especially important when it comes to considering new technologies, which may not fall within existing coding language. Without any structured information, early adopters of new technologies may find themselves trying to 'create' coding recommendations based on liberal interpretations of existing coding systems. Consequently, providers appreciate it when companies are able to provide a thorough and accurate understanding of what needs to be done for correct coding of claims involving their products. By complying with regulatory standards and adhering to a professional code of ethics, sales representatives will understand their limitations and will not sell reimbursement based on financial gain.

In spite of all the training that a company may provide its employees, reimbursement is ultimately in the hands of the company's customers. Consequently, all corporate marketing material should carry disclaimers indicating that correct coding and billing procedures are the responsibility of the provider. Also the materials should state that company recommendations are not intended to represent an indication of payment potential, nor are they to be construed as recommended guidelines for the establishment of policy, practice guidelines, or standards of care.

Copyright ©2007 MX

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