Making A Statement – Clinical Trials Billing in Epic and SAP Scott A. Streibich, MBA, MHS, CHRC, CBE Director, Research Compliance Operations Special credit to Liza Rodriguez, Associate Director – Clinical Research Billing Compliance
2 RSH Account Single Billing Office Statement 2
3 CRBC Review Criteria Study Has PRA Participant in CRMS Notification Only Active CRMS Status on DOS Standard Must be in CRMS prior to the Retrospective close of the Epic encounter or Candidate none of the review process function properly Consented Eligible Enrolled Follow-Up 3
4 Epic Research Indicator 4
What Does Research Linking Looks Like in Epic? 5
Charge Review 6
JHM Research Charge Workflows No No No Encounter Encounter Coordinator Patient Linked by Existing Global Review Linked by Reviews & Links Encounter Nurse or Scheduler? Using Report? Physician? Bill Only Study Paid Yes Yes Yes Yes Bill to Medicare Charges to RSH Coverage Account Yes Yes No No Medicare Adjudication Charges Billable to Coverage? Bill to Default Subject to PRA Study Account? Add Billing Coverage Codes 7
The Epic RSH Record – General Info 8
The Epic RSH Record – Report Groupers 9
5/4/2020 10 RSH Account Charges CPT Category Facility 10
How Research Fee Schedules Function Physician Services (Epic PB) Hospital Services (Epic HB) ► Fees based on 150% of Medicare ► Fees based on 100% (Govt/NFP) and 150% (Pharma/FP) of Medicare equivalent ► “Pre-discounted” ► 150% of Medicare fee is a substantial reduction from department “base” fee ► Maryland HSCRC determinates rates ► Fluctuate often ► Rates cannot be frozen in Epic ► No additional discounts taken on ► Discount using memo statement ► “Everything XX% Off” ► “Everyday Low Pricing” 11
5/4/2020 12 2020 Hospital Services Research Discount Rate 2019 (prior to April 2020) NEW 2020 Effective April 1, 2020 ► Government & Not for Profit Award ► Government & Not for Profit Award Sponsors Sponsors ► 35.7% (64.3% Discount) ► 28.9% (71.1% Discount) ► Pharmaceutical & Industry Contract ► Pharmaceutical & Industry Contract Sponsors Sponsors ► 53.6% (46.4% Discount) ► 43.2% (56.8% Discount) ► Effective March 1, 2019 12
13 Direct Study Billing 13
What if I Don’t Agree? ► Contact the sender of your statement. ► Hospital Billing ● RCM-R@jhmi.edu ► Physician Billing ● PBSResearch@jhmi.edu ► The account in question will be added to an Epic work queue. ► Please note the CRBC Manager will review the account. ► Disputed finding can be appealed to the Associate Director, CRBC, however their decision is final for all JHM research billing matters. 14
15 Participant’s Complaints ► If you get a participant complaint, please forward to CLINIRESBILLING@exchange.johnshopkins.edu ► If the participant calls customer service, the complaint will be reviewed by CRBC 15
Contact Information Scott Streibich Elizabeth (Liza) Rodriguez Director, Research Compliance Operations Associate Director, CRBC 410.361.8381 410.361.8380 sstreib1@jhmi.edu erodri13@jhmi.edu https://www.hopkinsmedicine.org/resear ch/resources/offices- policies/CRBC/resources.html CLINIRESBILLING@exchange.johnshopkins.edu 16
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