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.


Benefits of Coverage Analysis 

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Shorten the cycle time for coverage analysis in order to enroll patients sooner

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

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Streamline informed consent review to alleviate discrepancies between documents

Reduce overhead by partnering with PFS Clinical and include our cost in study start-up


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 guidelines

  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 Q0/Q1 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