Insights from the forefront of clinical research compliance and revenue management.
A New Model for Managing Medical Research Billing, Preventing Insurance Fraud, and Negotiating Budgets with Trial Sponsors
For more than two decades, research institutions have relied on Coverage Analyses as both a compliance tool and a budgeting foundation. This book argues that changes in insurance reimbursement — particularly under the Medicare Outpatient Prospective Payment System (OPPS) — have broken that model. The result: hidden losses for institutions, increased legal risk, and a widely held but empirically false assumption that insurance coverage equates to payment.
The book introduces the Research Payment Analysis (RPA) — a methodology that replaces coverage determinations with empirical reimbursement data as the basis for sponsor budget negotiations, stronger compliance, and faster time-to-activation.
Written for clinical research administrators, hospital revenue cycle professionals, health care lawyers, and compliance officers.
Medicare Coverage Principles, Institutional Billing Decisions, and the Limits of Predictive Compliance in Clinical Research
A companion to the Coverage Analysis Reminder video modules, this white paper examines the foundational principles that every charge reviewer should internalize — from the three reasons a service is not billable to health insurance, to the critical distinction between Medicare coverage and clinical standard of care.
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