Overcoming Challenges in Clinical Trial Billing

Clinical trial billing is one of the most difficult processes in the healthcare. It includes all kinds of services and items, including, non-routine and routine services and items. Essentially when you go to any medical service provider, such as a hospital, a clinic, or a private practice, the medical personnel there identify the service you desire using hospital coding guidelines. Following this, billing happens through the use of the same coding identifiers. Therefore, when you go to any medical service provider such as a hospital, a clinic, or a private practice, for any service related to a clinical trial, there are special hospital coding guidelines for such services, both routine and non-routine. Like all other medical services, clinical trial billing happens through the use of the specific coders referred to under hospital coding guidelines.

If you have ever associated yourself with clinical research, it is highly likely that you have faced with how one deals with billings for services and items that are received by the study participants over the period of a clinical trial. It is true that there are different and contrasting requirements for payers and, there often is a lack of proper coordination between research sites, sponsors and investigators. This has made clinical trial billing a challenge in to those institutions involved in the clinical trial. The hospital coding guidelines that are based on complicated Medicare rules makes it even more difficult to get the clinical trial billing right.

There are some steps that one could take that can raise the probability of proper billing in regard to the research of which you are a part.

If you are negotiating with a research sponsor for a sponsorship agreement, acting as an investigator for the study, you can involve hospital billing (especially clinical trial billing) and research administration in the discussion early on, even if there is no process in place in the hospital for centralized sponsorship agreement negotiation. Through the course of a trial, you may also keep dialogue open with hospital billing personnel, so that queries from both sides related to clinical trial billing can be addressed effectively, and in consonance with hospital coding guidelines. Finally, you may also press the hospital administration to consider and have a central office that will be responsible for clinical trial compliance (with a focus on clinical trial billing), that is, if the hospital does not have such a central office already to implement this function.

These steps might not guarantee you proper clinical trial billing; however, it will assist you to access resources that will help you in appropriate clinical trial billing under hospital coding. Moreover, you will also be provided with resources that might help you navigate through the maze of clinical trial billing.

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