Clinical Research Billing 101: The Financial Fundamentals to Succeed With Claims, Conversations, and Compliance - On-Demand

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Clinical Research Billing 101: The Financial Fundamentals to Succeed With Claims, Conversations, and Compliance - On-Demand

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Clinical Research Billing 101: The Financial Fundamentals to Succeed With Claims, Conversations, and Compliance - On-Demand

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Available ON-DEMAND

Presented on:
Thursday, June 28, 2018

Presented by:
Linda Yancey, RN, CCRA, cofounder of Research DefinED, LLC
Mary Veazie, MBA, CPA, CHC, CHRC, cofounder of Research DefinED, LLC

Level of Program:

Sponsored by:
Revenue Cycle Advisor

In an innovative healthcare world, clinical research trials are the key to finding ways to quickly and effectively treat patients. But while clinical trials can signal a brighter future for the patient, facilities who lack training on how to appropriately bill for these services risk denials, inappropriate reimbursement, and even exclusions from federal healthcare programs. As commercial insurance companies begin to adopt Medicare policies for clinical research billing, it is increasingly important for any facilities offering or planning on offering these services to master Medicare’s rules and regulations on the topic.

During this 90-minute webinar, clinical research billing experts Linda Yancey, RN, CCRA, and Mary Veazie, MBA, CPA, CHC, CHRC, will provide a comprehensive overview of everything a facility needs to know to get started in successful clinical research billing. The program will address the key modifiers and medical trial numbers necessary for reimbursement, the intricacies of documenting medical necessity for clinical research, best practices for conducting conversations with patients and patient care staff about the financial aspects of clinical research, and methods to differentiate between research care and routine care on a claims form. When equipped with accurate clinical research financial knowledge, facilities will not only avoid the loss of revenue associated with insurance denials—they will also enhance their ability to better care for their patients by expanding into the clinical research world.

At the conclusion of this program, participants will be able to:

  • Describe the significance and utilization of the Medicare Coverage Analysis for clinical research treatment billing
  • Develop insight for creating a process to discuss the financial implications of clinical trials with patients as well as their care teams
  • Recognize components required for claims forms to ensure compliance with Medicare regulations and use correct modifiers and clinical study numbers for research trials
  • Identify medical documentation techniques to improve pre-authorizations and reduce denials with research care
  • Create a billing process for clinical research trials to help make these treatments financially feasible for the facility

Who Should Listen?

  • HIM managers and directors
  • Coding staff
  • Coding managers and directors
  • Revenue cycle managers and directors
  • Revenue integrity staff
  • Billing staff
  • Patient financial services
  • Patient access staff
  • CDI managers and staff
  • Patient care staff


  • Introduction to the basics of the Medicare Coverage Analysis for clinical research treatment
    • Overview of NCD 310.1 (routine costs in clinical trials)
    • Discuss the financial differences between research care and routine care
  • Exploring billing grids and guidelines
    • Understand how to use them to route charges
    • Discuss scenarios when the billing grids are not applicable
  • Refining claims processing for clinical trials
    • Review of modifiers -Q1 and -Q0
    • Determine when and where to add modifiers
    • Discuss where to find the clinical study number and where to put it on a claim
  • Conducting financial discussions with patients and patient care teams
    • Ensure pre-authorization teams know how to differentiate between routine vs. research care in a clinical trial
    • Create a pre-authorization process to prevent problems down the line
    • Identify where patient care teams play a role in documenting services necessary for pre-authorization, claims processing, and minimizing denials
  • Impact of Medicare program participation on denials management
    • Rationale for denying sponsor reimbursements
    • Options to resolve the situation for patients’ benefit
  • Live Q&A


  • Financial Clearance Template for Research Patient Discussions

Continuing Education

(Live + On-Demand) - This program has been approved for 1.5 continuing education units for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA).

(Live + On-Demand) - This program has the prior approval of AAPC for 1.5 continuing education hours. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Ability to claim credits for this webinar expire on: 6/27/19

Meet the Speaker

Linda Yancey, RN, CCRA

Linda Yancey, RN, CCRA, is cofounder of Research DefinED, LLC, an educational consulting firm that helps the healthcare and research community develop the skills necessary for clinical research quality and operational efficiencies. She is a clinical research professional with a history of orchestrating successful multi-institutional academic clinical research consortiums and strategic pharmaceutical collaborations designed to decrease clinical trial activation timelines and reduce financial operating associated costs. Yancey holds Bachelor of Science degrees in both Business and Nursing. She is a Certified Clinical Research Associate and has an extensive background that includes mass tort legal nurse consulting, auditing/monitoring per GCP/FDA regulations, FDA site inspections, clinical trial management system development, clinical research billing compliance, project management, and pharmaceutical strategic alliances.

Mary Veazie, MBA, CPA, CHC, CHRC

Mary Veazie, MBA, CPA, CHC, CHRC, is cofounder of Research DefinED, LLC. Veazie is a Certified Public Accountant with over 15 years of experience in clinical research finance. Collectively, she has more than 25 years of financial and auditing experience. She developed and directed a clinical research finance office for a large academic medical center. She is certified in Healthcare Research Compliance and Healthcare Compliance. Veazie’s skill set includes the clinical research billing process and its impact on an organization’s clinic operations and revenue cycle.

Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

No problem. The On-Demand version is also available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $259 value! 

Participation in the webinar is just $259 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email if you have questions.