The Basics Of Coverage Analysis

Billing compliance is a highly prevalent matter in research administration. As such, institutions are continually looking for ways to ensure compliance, one of which is coverage analysis.

Coverage analysis is the process of reviewing a clinical trial protocol and determining which items and services can be billed to the study sponsor, and which can be billed to insurance. Though tedious, the process is crucial to the administrative wellbeing of a study, and can help prevent costly errors that lead to billing non-compliance.

Medicare has strict rules that state a provider cannot receive payment from one party for a service and bill Medicare for that same service. Also known as “double billing,” this process is a severe form of Medicare fraud. However, by conducting a coverage analysis, you can avoid this mistake.