Clinical Research Charging Accuracy
We have not engaged in a single research billing integrity project where revenue loss was not identified on clinical study protocol visits. Despite the excellent reputation of academic medical centers on Cerner/Epic with CTMS interface and centralized research billing workflows, errors and process gaps occur routinely.
Significant Revenue Losses
Payable charges for patients in clinical trials are often billed incorrectly or simply overlooked. Unfortunately, Revenue Cycle managers struggle with a lack of subject matter expertise combined with complex billing and compliance regulations.
The assumption "Clinical Trial Sponsors" pay all medical costs for patients enrolled in the trial … is simply not true. Back-end Payer denials and charge-off's reveal this important fact: Trial sponsors will only pay for activities specifically prescribed by the protocol that are NOT standard of care. Providers must bill the correct Payer for all non-protocol activity. The resulting confusion causes significant revenue loss.
Forward thinking managers are asking "How can we improve charging accuracy on Clinical Trial accounts?"
HIP's Charging Accuracy Audit Program
HIP Nurse Auditors are Subject Matter Experts in this complex field. Clinical Trial accounts are carefuly screened to ensure all payable charges are billed to the correct Payer ensuring accurate and compliant reimbursement. To learn more, contact Joseph A. Farris @ HIP (866) 622-8300 x102 JFarris@HIP-inc.com
Credentialed, Experienced staff conduct ongoing concurrent documentation review of Inpatient and Outpatient Accounts
Education provided to clinicians to improve specific documentation areas
Periodic audits conducted retrospectively to assess CDI impact