2015 Annual Training Conference & Anti-Fraud Expo

Sessions Speakers Exhibitors Show Specials Floor Plan Buzz

Clinical Trial Billing Compliance (Room Gaslamp A-D)

18 Nov 15
2:15 PM - 3:15 PM

Tracks: Clinical Issues for the Health Care Fraud Investigator

Two modifiers, one diagnosis code and a requirement to supply the clinical trial number make coding services associated with clinical trials a challenge. Insurers are sometimes required to reimburse for routine services, but some payors may not have to pay for anything related to a clinical trial. The Affordable Care Act has impacted trial reimbursement, but the extent of payment may still be in question. This session will review definitions of routine and investigational services, explore public audits and investigations involving clinical trials and provide examples of correct and incorrect modifier and diagnosis code reporting.