Claims Processing: Appropriate Segregation of Charges & Medical Documentation for Clinical Research Studies

Why Should You Attend:

Participants will learn the process of capturing charges and the associated medical documentation for appropriate processing to the appropriate payor(s) – third party insurance companies or clinical trial sponsors. This information is vital to the revenue cycle associated with clinical trials.

Participation in clinical research activities presents challenges for an already complex revenue cycle and insurance system. Ensuring that the patient care services are routed to the right payer in the context of a clinical trial can be described as “threading a needle.” When the United States moved from ICD-9 to ICD-10 in 2015, a growing need for more detailed medical documentation became essential, especially in the clinical trials realm. Medical documentation is the sole source of information to use when determining how to report the items and services provided to a patient. Medical documentation must be thorough and clear so that coders can accurately and completely code for all conditions that apply to the patient. Participates in this course will understand the segregation of duties process and the appropriate medical documentation that must accompany these charges when billing third party payors.

Areas Covered in the Webinar:

• Understand the charge capture process
• Understand segregation of charges process
• Understand charges billable to insurance/patient
• Understand charges billable to sponsors
• Understand medical documentation
• Learn why medical documentation is important for charges billable to insurance/patient
• Understand claims processing
• Learn impact of charge capture on the revenue cycle for a clinical trial
• Learn impact of medical documentation on the revenue cycle for a clinical trial

Who Will Benefit:

• Clinical Research Coordinators
• Clinical Trial Managers
• Clinical Research Associates
• Clinical Research Managers/Directors
• Administrative Directors
• Financial Analysts
• Clinical Business Managers
• Clinical Business Directors
• Charge Capture Specialist

Academic Medical Centers, Academic Universities involved in clinical research, community based hospitals.

Free Materials:

• Reference documents
• Rule documents or guidance

Mary Veazie
Executive Director, Clinical Research Finance

Mary Veazie is a Certified Public Accountant with over 15 years of experience in clinical research finance. Collectively, she has over 25 years of financial and auditing experience. She developed and directed a clinical research finance office for a large academic medical center. She is certified in Healthcare Research Compliance and Healthcare Compliance. Ms. Veazie’s skill set includes full comprehension of the clinical research billing process and its impact on an organization’s clinic operations and revenue cycle.

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