decisionhealth Newsletters, Part B News - 2008 Issue 9 (September)
4 steps to boost your revenue through clinical trials
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Article Overview
This premium article discusses how physician practices can participate in clinical trials as a potential revenue source and why Medicare carrier approval is an important part of the process. It is aimed at billing, coding, and practice management professionals who want a high-level understanding of the steps involved in working with trial sponsors, securing coverage for routine care and investigational device costs, carrying out the trial, and filing claims. The article also touches on the general kinds of coding and modifier guidance associated with clinical trial billing.
Why This Topic Matters
Clinical trial participation can affect practice operations, payer relationships, and claim submission workflows. Understanding the broad process helps billing and compliance teams evaluate whether a trial opportunity is administratively feasible and how it may affect reimbursement.
Article Sections
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Overview of clinical trial revenue opportunities
Introduces the idea of clinical trials as a practice revenue option and explains the roles of sponsors and Medicare at a high level. It also frames the operational and specialty-related considerations that affect whether a trial is a good fit.
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Four basic steps to get into a clinical trial
Summarizes the general sequence of steps involved in participating in a clinical trial. The section covers sponsor contracting, Medicare coverage requests, trial performance, and claims filing.
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Tip: Ask the trial sponsor for help
Provides a brief note about working with the sponsor when communicating with the carrier. The focus is on coordination and support during coverage discussions.
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Remember: Use modifier guidance for clinical trial claims
Highlights the article’s general billing and coding reminder for clinical trial-related claims. It addresses the use of coding-related identifiers in the context of routine clinical service and investigational service reporting.
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On the Internet
Lists an external clinical trials resource maintained by a federal organization. The section is informational and points readers to a public registry.
What You Will Learn
- How clinical trials can create a potential revenue stream for practices
- What general steps are involved in setting up participation in a clinical trial
- Why Medicare carrier approval is important in clinical trial billing
- What broad types of billing and coding considerations arise in trial-related claims
- Where to find a public clinical trials registry
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Compliance teams
- Physician office administrators
Codes Discussed
Modifiers Discussed
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