Transcript Billing Grid - University of Tennessee Health Science Center

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• Correct charge
• Correct amount
• Correct payer
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• Discuss the purpose of a Billing
Grid
• Discuss the Billing Grid process as a
means to obtain/communicate
accurate billing
• Understand and complete the steps
to filling out a Billing Grid
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• Study Procedures can be paid by:
•Sponsors
• 3rd Party Payers:
•Private Insurance
•Medicare
•Medicaid
• Study Procedures are not being reimbursed
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Improper billing can lead to false claims
Improper
Billing
Penalties
False
Claims
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• Billing a participant/insurance company
for research-only procedures
• Billing a participant/insurance company
for services covered by the sponsor
• Billing for services promised free in the
ICF
• Billing the study for services that should be
billed to the sponsor
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Consequences of Incorrect Billing:
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Fines
Committing fraud
Loss of time correcting error
Failure to recover costs
Criminal penalties
Financial penalties
Loss of Community trust
Restriction on research operations
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• Requires due diligence by all
• Informing subjects of financial obligations
and liability (ICF language very
important)
• Complete billing grid (indicates where
specific charges should be billed)
• Ensure services for study procedures are
billed in accordance with the billing
grid
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• Complexity of the trial
• Procedures
• Reimbursement payment
• Procedures not associated with a
CPT/ICD code
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Accurate Billing of
procedures associated
with clinical trials
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• Start the process during contract/budget
negotiation
• Make sure it is clear what the sponsor is paying for
• Differentiate between SOC and research
procedures where SOC procedures are not being
reimbursed by the sponsor
• Read and evaluate the protocol, ICF (draft is fine)
and budget
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• Requires communication between the following:
•PI
•Coordinator
•Study Team
•Clinic/Department manager
•Clinic/Facility front desk
•Clinic/Facility billing department
•Additional departments that may provide services for
research procedures
•Coders
•Subject
Requires oversight by study personnel and
Billing department
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Refer to handouts
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Documents required for a thorough
analysis:
•Protocol
•Schedule of events
•Contract (may not see until fully executed)
•Budget
•ICF
•CRF
All of these documents have to contain
consistent language in regards to the payment
of protocol procedures
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Step 1:
Complete the header information
Step 2:
Using the protocol, schedule of events,
ICF, and CRF (if available) to complete the
procedure and visit information
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Step 3:
Detail each subject Visit
Step 4:
Fill in which procedures will be performed
at each visit, indicating this with an X
Step 5:
Determine which of these procedures are
paid for by the sponsor and mark with an R
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Step 6:
Determine which of the remaining
procedures are SOC and mark as B
Step 7:
If any procedures are uncompensated mark
with a U
Step 8:
If any remaining procedures cannot be
determined to fit into any of these
categories, leave as X until assigned by the PI
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Step 9:
Discuss the Billing Grid with the research
team, especially the PI
(PI will have the final determination re:
the category of billing for each procedure as
indicated with his/her signature on the grid)
Step 10:
Distribute to “ALL”
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Billing Grid
Assure
Accuracy
Track Billing
Communication
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