Research Billing Compliance at MedStar Health

Research compliance encompasses a wide variety of issues including research billing. Billing compliance ensures all services in a trial are paid for by helping to reduce double billing and preventing billing for services that are not covered by the trial or are not medically necessary for the research subject. Accurate billing in research is a complex and challenging process that requires a diverse group of professionals across MedStar Health to work cohesively and collaboratively with one another. We at the Research Institute seek to ensure that we have an efficient and compliant approach to billing compliance.

The research coordinators have the most critical step in the clinical research revenue cycle process. Research subject visit tracking directly drives financial management and compliance. This is the first line of defense against erroneous billing. Subject visits must be logged in OnCore within one business day to ensure timely review by the MHRI revenue cycle team for MedStar Health to maintain compliance with the Centers for Medicare and Medicaid Services (CMS) Clinical Trial Policy.

MHRI strives for efficient, compliant and transparent research billing by providing monthly metrics and encourages internal audits. In FY20, MedStar Health completed two internal research billing compliance audits which were favorable. In addition, Research Operations provides monthly metrics showing corrections made to a subject’s account before a bill is automatically sent to Medicare or a commercial payor. 

Thank you to the research coordinators and the Research Institute research revenue cycle team for all the hard work you put in daily! Know that it is recognized and greatly appreciated.

If you have any questions about research billing compliance or the process within OnCore, please contact [email protected].