The Billing Risk Analyst oversees two important components for the Clinical Trials Office, the Billing Risk Review for your study and Maintaining the Epic Research Workqueue for patient charges related to your study.
A Billing Risk Review involves examining protocols and other IRB documents to assess what study services are taking place, where they are happening, and who is involved in the execution of these services. Human research studies with clinical services taking place where a billing system is present, such as Epic, pose a billing risk. If a study is deemed to have a billing risk, measures will be put in place to prevent any inaccurate billing to the study sponsor, our research participants or their 3rd party payors.
Billing Risk Analyst tasks include the following:
- Review of new and amended Protocols
- The billing risk team receives notification from the IRB of new studies or amended protocols requiring review.
- Register studies in Velos
- The billing risk team registers studies in Velos and maintains the study’s Active and Inactive Status.
- Build Coverage Analysis
- The coverage analysis is developed from information provided in the protocol and input from the research team.
- Create Patient Calendars in Velos
- The billing risk team utilizes the coverage analysis to create the patient calendar(s) in Velos along with the protocol and input from the research team.
- Confirm and Assign Training
- For studies that possess a billing risk, the billing risk team ensures that members of the study team have completed the CTO’s Management of Billing Risk Training in
Maintaining the Epic Research Workqueue is done in coordination with the Velos Clinical Trials Management System (CTMS). Research participants are registered to the study in Velos by the research team. The Velos interface with Epic will ensure that research participants’ charges will filter to a special research workqueue for review by the CTO’s Billing Risk team. Charges in Epic are compared to visit data entered in Velos by the research team and determined to be study-related or part of the participant’s standard of care and billed accordingly. Billing Risk Analyst tasks include the following:
- Initiate the creation of the Epic Research Accounts
- Review research participant charges to ensure they are billed appropriately
- Help to resolve research patient and department billing issues
Velos Clinical Trials Management System (CTMS) is used to track patient enrollment and progress on the study. Patient registration and statuses are communicated to Epic in “real-time”.
- Timely registration of participants to your study is crucial. The institute requires that participants be registered for the study within 24 hours of signing their consent forms. Subsequent visit data should be entered within 24-48 hours of occurrence
- Some budgets reimburse for screen failures so it’s important that all subjects that signed consent be registered to your study even if they screen failed or withdrew.
Important items to consider
- Timely responses to inquiries related to your study’s billing risk assessment can prevent delays in institutional approvals.
- Timely responses to patient data inquiries can prevent frustration to our research participants and loss of revenue
- Participation from the research team in the development of the coverage analysis and patient calendar and increase the accuracy and prevent complications down the road.
- Failure to Maintain participants’ study status in Velos directly affects the volume of charges that require review and dissipates CTO’s staff resources.
- A delay in registering participants to your study in Velos can cause errors in charges billed to patients or their insurance companies.
- If patient data is not up to date in Velos we are unable to verify patient charges. This will result in email queries to the research team for charge verification and the risk of losing revenue due to timely filing deadlines.