Medicare Qualifying Trial Determination and Billing Risk Assessment

YCCI is responsible for:
  1. determining whether a study is deemed to be a Medicare Qualifying Trial (MQT); and 
  2. assessing the billing risk associated with a designated MQT study.  Note that studies deemed not to be a MQT will not have any procedures billed to insurance. 
Before billing 'routine costs' associated with a clinical trial to Medicare or other insurance carriers, YCCI determines if the trial meets the CMS qualifying criteria. For information regarding qualifying/non- qualifying clinical trials under the Clinical Trial Policy (CTP) National Coverage Determination (NCD), please click here for more information. Once a research study is identified as a MQT, the Billing Compliance Quality Assurance Team completes a risk assessment determination as to whether a clinical trial is high, moderate, or low risk for research billing compliance purposes.