Revenue Guard Services: Claims Review & Adjudication

The government estimates that about 8.5% of all Medicare FFS claim payments are flawed, and errors stemming from faulty claims review are huge contributors to these losses*. In fact, in the health care industry alone, billions of dollars are lost every year from errors like these.

The clinical trial claims review service from PFS Clinical is a turn-key solution for outsourcing this critical element of your research administration.

Benefits oF Claims review

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Ensure delivery of accurate claims to the appropriate party (16).gif

Prevent timely filing issues with all payors (11).gif

Increase clinical trial revenues to retain staff and better the bottom line (15).gif

Decrease potential billing errors, compliance concerns, and denials (3).gif

Take advantage of a streamlined solution to prevent internal duplicate efforts


Claims review Process

  1. Reconcile patient visits against coverage analysis within CTMS to select appropriate payor
  2. Perform bill adjudication within financial system for appropriate charges
  3. Invoice sponsor for payment, if required
  4. Prepare claims with accurate modifiers and codes
  5. Send to appropriate 3rd party payor
  6. Reconcile both sponsor payments and 3rd party payor accounts receivable
  7. Manage research patient denials and/or perform collection calls to sponsors


Additional revenue guard Services:

Financial Management