(精选)【医学英文课件】 Clinical Research Billing Coding教学课件.ppt

PREPARED BY: SUZAN BRUCE, CPC CLINICAL TRIALS OFFICE, UC DAVIS;;Medicare Clinical Research Coverage;Medicare Coverage Analysis;;What is covered in a clinical trial?;What does Medicare/Insurance or Study pay for?;Items and services NOT billable to Medicare;Modifier Q0/Q1;Things to know:;EXAMPLES OF WHEN TO USE MODIFIERS, DX AND CONDITION CODES; The patient is in an investigational drug research study for cancer. An investigational drug is provided for free by the sponsor and all other drugs are billed to patient’s insurance (Medicare). All billable drugs are FDA approved and part of the investigation. “Q0” modifier identifies these billable drugs as part of the “objective” of the investigation;Take-away Points;;Billing violations under the False Claims Act;Why is clinical trial billing at risk for compliance errors?;Why is research billing compliance critical?;The 3 C’s of Research Billing Compliance;Are there exclusions or limitations on coverage?;Resources