decisionhealth Newsletters, Part B News - 2000 Issue 11 (November)
Payment rules for clinical trial patients updated
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Article Overview
This brief coding update covers HCFA guidance affecting claims for patients enrolled in clinical trials, with emphasis on how the diagnosis information must be positioned on the claim, which claims require an added modifier, and when the revised payment rules apply. It is aimed at coders, billers, and revenue cycle staff working with physician, intermediary, regional home health intermediary, and home health agency claims tied to clinical trial services.
Why This Topic Matters
Clinical trial claims can be denied or paid incorrectly if reporting requirements are not followed. This update helps billing teams understand the scope of the revised guidance and the claim elements affected by the memorandum.
What You Will Learn
- The general claim-reporting requirements tied to clinical trial-related services
- Which organizations and claim types are affected by the guidance
- How the update changes the timing of payment eligibility under the memorandum
- How a required modifier is associated with these claims
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Home health billing staff
- Physician practice staff
Codes Discussed
Modifiers Discussed
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