Purpose of Research Billing Ensure that charges for research participants are reviewed for appropriate routing to participant insurance or to the research study Institutional RolesResponsibilities ID: 1043826
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1. Research BillingJennifer Brumfield, RN, CCRC, MHS
2. Purpose of Research BillingEnsure that charges for research participants are reviewed for appropriate routing to participant insurance or to the research study
3. Institutional Roles/ResponsibilitiesUniversity of Mississippi Medical Center(UMMC): Facilitates the relationship between the UMMC faculty investigators and the various sponsors of scientific and scholarly knowledge; ensuring sponsored projects are administered in accordance with sponsor regulations and UMMC policies. Principal Investigator: Complete required documentation to support charges for each research participant. Accurately bill medical professional and technical research charges to appropriate payor source (e.g., grant; third party payor; or to the research participant).
4. Clinical Research Billing ComplianceServices reimbursed by study sponsors CAN NOT be billed to third party payors. Third party payors usually only pay for services that are accepted in the medical community & frequently exclude payment for experimental or investigational services. Study participants should be aware of any out- of-pocket costs resulting from participation in the study.
5. Research Billing TermsBillable EventCharge Billing Form (CBF)Double BillingFunding AgreementNon-Billable Event
6. Billable EventPatient care services or items such as a clinic visit, procedures, radiology, labs, etc. that may generate a charge into the healthcare billing system. These charges should have a CPT code.
7. Charge Billing FormIdentifies all study related proceduresIncludes medicationsShould be final prior to the starting research related proceduresDo not for get additional charges (i.e. venipuncture, injection, etc.)
8. Double BillingDouble billing occurs when the same service is paid by two different sources.This should not occur.
9. Funding AgreementThe legally binding agreement between all parties that include the fiscal information (budget, payment terms, invoiceable items, etc) related to the study.
10. Non-billable EventAn item that is provided at no cost and/or does not generate a charge in healthcare billing systems. Examples include labs sent to central lab for processing, or providing a participant with an investigational product.
11. Research Billing ProcessEnroll the participant in the research study
12. Research Billing ProcessOrder Labs, procedures, etc.Affiliate the charge with the research study.
13. Research Billing Process
14. Research Billing ReviewResearch Billing Specialist Will send research coordinator an email with all chargesResearch coordinator should verify all charges are correctCheck charges for your encounter (Keep in mind patients may be participants in several different studies).
15. ConclusionPrior to site activation, outline a schedule of events to ensure you capture every potential charge on the CBF.When the protocol updates, check for new charges and submit new CBF if applicable.Communicate with the principal investigator and Office of Clinical Trials if you have any questions!
16. Question!