Initiate Services: Coverage Analysis

Medicare billing rules are notorious for their complex and often confusing language. Those rules make it difficult for research sites to determine which procedures and tests should be billed as routine and conventional costs and which should be billed to the study sponsor.

The coverage analysis service from PFS Clinical is a turn-key solution for outsourcing this critical element of your research operation.

Benefits of Coverage Analysis 

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Diminish the potential for improper billing that could impact your Medicare standing

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Reduce costs by outsourcing this activity while passing the expense to the sponsor as a reimbursable study start-up item

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Shorten the cycle time for coverage analysis completion


Streamline informed consent review to alleviate discrepancies between documents


Coverage Analysis Process

  1. Analyze each study to determine if it is a qualifying clinical trial per Medicare guidelines
  2. Perform a thorough review of the clinical trial agreement and informed consent to ensure consistency with the protocol and billing regulations
  3. Complete a coverage analysis of all procedures and tests outlined in the protocol and document the supporting rationale for each determination using local and national guidelines
  4. Apply proper modifiers and CPT codes to the study grid
  5. Ensure accurate trial information is entered into a clinical trial management system for the study team


CTMS Implementation | Budget and Contract Negotiations