A Beginner's Guide To Medicare Coverage Analysis

A medicare coverage analysis (MCA)—also known as coverage analysis—is a systemic process of developing a billing plan for a clinical research study. Based on guidelines adopted by federal agencies, the MCA provides an in-depth analysis of how all the items and services listed in the clinical research protocol are billed.

The Centers for Medicare and Medicaid Services (CMS) provides information and guidelines to determine whether billable items and services are to be billed to the third party (insurance/patients) as a routine cost or will be paid by the sponsor as a research-related procedure. Since 2000, Medicare has covered the cost of routine care for Medicare beneficiaries who are enrolled in qualifying clinical research studies. Effective January 2022, Clinical Treatment Act requires all U.S. states and territories to cover the cost of routine care for Medicaid beneficiaries who are participating in a qualifying research study.

Learn how a developed billing plan by performing MCA can help individual research sites and sponsors estimate their expenses on protocol-required items and services.