2013 ccaf clinical trial billing & operations
DESCRIPTION
2013 CCAF Clinical Trial Billing & Operations. Michael Bertram, PhD, MBA Associate Director For Administration UAB Comprehensive Cancer Center. March 11th, 2013. UAB Background. Matrix University: Research Compliance Independent IT Group UAB Medicine: Inpatient/ Hospital using IDX - PowerPoint PPT PresentationTRANSCRIPT
Michael Bertram, PhD, MBAAssociate Director For AdministrationUAB Comprehensive Cancer Center
March 11th, 2013
2013 CCAFClinical Trial Billing &
Operations
Matrix– University:
Research Compliance Independent IT Group
– UAB Medicine: Inpatient/ Hospital using IDX Outpatient Using Cerner Millennium/HealthQUest Independent IT Group Separate Billing March 1st, 2014All clinical entities under UAB Hospital Umbrella Transitioned to Provider Based Billing
UAB Background
Legal Action– Gober/ USA vs UAB-Whistleblower Lawsuit– Clinical Trial Double Billing Settlement– University Reaction
Reactive Era– Central “CTMS” Acquired– Centralized Clinical Trial Billing Control– Institutional Clinical Trial Billing Policies & Procedures– 100% Audit of Inpatient Subject Visits
3rd Party Payer– BCBS of AL 90% of non-CMS Market– Reluctance to cover RCC for CT Participants
UAB Background (Continued)
Cancer Center Review– Determination of Medicare Coverage
Protocol Review ICF Review
– Separate Allowable Costs (First Pass)– Medicare Supplemental Coverage Review – Clinical Event Review with PI– Review Language for Consistency
Institutional Review– Newly formed Institutional CTO– Clinical Billing Review
Pre-Activation Routine Care Cost Identification
Institutional Process
Approved Protocol Routine Care Cost Patient On Trial Patient On Treatment Patient Off Trial Patient Schedule Patient Visited
– Scheduled items occurred or not– Unscheduled items occurred
Active Trial Communications
Streamline Routine Care Cost Review– Coverage Analysis System– Share Electronically– Document In One Place
Integrate Systems– Allow free flow of information between entities– Improve Timeliness– Improve Accuracy– Eliminate Redundancy
Improvements
Culture and Process are Compliant- Systems & Tools are Not
OnCore CTMS-Cancer Center– MPI/EMMI Interface– Coverage Analysis Module– Documents Routine Care Cost Analysis– Planned Visit Report– Clinical Trial Billing Notice
Cerner Millennium (PowerTrials and PowerPlans)– Billing Path Based on Coverage Analysis– Built in Upfront as Part of Activation Process
Tools in the Toolbox
Questions