Kelly M. Willenberg (email@example.com) is President and CEO of Kelly Willenberg, LLC in Chesnee, SC.
You cannot win in clinical trial accounts receivable unless you stay on top of it. A site cannot afford to sit on claims that were denied due to common mistakes, such as a forgotten modifier or a missing Z00.6 diagnosis code. The best practices are being aggressive by turning these around the same day you realize the mistake and not leaving it to the next day. If you don’t fix it right away, you could allow a “write off” and that is not a good process in clinical trial billing.
Denials can turn into a Medicare patient not getting the best deal, or “the most favored nation” status. That means that if you provide a service for free or at a lower cost for one patient, you should ensure that all the other Medicare patients on the same trial get the same deal.
There are four ways to win in the ugly world of denials:
Have a form letter and pre-authorize all clinical trial patients as you would a patient who is not enrolled in a study.
Look for missed revenue from payer differences or variances based on the coverage analysis.
When it comes to your financial counselors, create clinical trial experts and train them on the nuances of clinical trial billing.
Write offs should not be done routinely. If a particular patient receives an item or service for free, you must provide that same service to a Medicare patient at the same time point.
Losing revenue is a common problem for collections in clinical trials. Accounts receivable is often not well managed, nor is it easy to identify if you are losing money. When you consider that you must collect from payers for the routine/conventional care, as well as collecting from sponsors for research costs and administrative work, the task can be enormous unless there is dedicated staff.
Managing collections from sponsors without electronic systems, including Clinical Trial Management Systems (CTMS), is a daily review of protocol services for each study. Invoiceables can be difficult to manage on paper. It is arduous when there is no method for a coordinator to track each patient visit. They must maintain a list pre-study procedure, visits, adverse events, unscheduled visits, etc. Someone may need to generate invoices and manage collections, tracking, and follow-up. The multiple steps include a maintaining a calendar for patients, updating timelines, and always ensuring that the accounting is up to date. This will add to the timeliness of collections.
The trick to winning involves managing nonpayment from trial sponsors, increasing your efficiency, and containing costs. Win or lose, all of this will help your research site succeed.