Research Billing Compliance QA

The Research Billing Compliance team is responsible for conducting:
  1. An initial protocol billing compliance assessment; and
  2. A proactive risk-based bill review of randomly selected Medicare Qualifying Trials. 
The protocol for conducting a research billing compliance assessment is based on specific clinical trial criteria, scored, and evaluated for one of three levels of risk: high, moderate, and low.

Based on the billing compliance risk determination, studies are randomly selected, and a predetermined number of subjects are reviewed both initially and as part of an ongoing maintenance review plan.  The purpose of these reviews is to ensure proper billing early in the study thereby avoiding any negative downstream effects.