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Uh-Oh! I Forgot About Getting Paid for My Products


Getting your ideas to patients can be overwhelming. Getting paid for them is another story.

Getting your ideas to patients can be overwhelming. Getting paid for them is another story. Too often, instead of having a proactive plan, reimbursement becomes an afterthought. In the meantime, the meter is running, cash flow is drying up, and investors are getting nervous. In short, you need a plan.

A better approach is to make reimbursement (ie, who will pay you, how, how much, and when) should be a core component of your business model canvas or business plan and should be developed and executed simultaneously with your IP, regulatory, and business model plan.

Here are the 10 biggest mistakes bioentrepreneurs make about reimbursement:

1. They don’t start worrying about it until they get FDA clearance.

2. They think that just because they get FDA clearance, Medicare and Medicaid will pay for it, erroneously assuming that one agency talks to the other.

3. They fail to get the right codes.

4. They fail to do the groundwork required for insurance coverage.

5. They don't get paid enough.

6. They fail to understand that getting RVUs assigned to a given product or procedure is a political process, not a rational economic one. They also haven't figured out how to operate 72 hours a day.

7. They don't understand the players at the table and how they play the game. Here's primer on the alphabet soup of payment.

8. They forget about cost-effective analysis, even though everyone else tells you it is not important or legal to consider.

9. They have one strategy for all payers in the world, when, in fact, payers are very different depending on the sick-care financing system of each country.

10. They don't hire the right people to help them, thinking they can do it themselves because it is cheaper to do it that way.

Getting reimbursed is mostly about codes, coverage, cost-effectiveness, and cash. If you ignore those 4 C's or pay attention too late, you'll be left with a basement full of gadgets or bottles of stuff that you can give away for presents at the bankruptcy hearing.

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Victor J. Dzau, MD, gives expert advice
Victor J. Dzau, MD, gives expert advice