Note on Health Insurance Coverage, Coding, and Payment

This note explains how health care technology and service innovators receive payment from government insurers, in the U.S. and abroad, and from private insurers. It describes each of the three steps needed to obtain reimbursement: coverage, coding, and payment. It also discusses how technology assessment techniques are used to reach coverage and payment decisions, FDA requirements, and recent payment developments. It concludes with an assignment that asks the students to classify the importance of each of the payers described in the note in achieving payment for three innovative technologies.