Hand-in-Hand:Research and Billing Wendi R. Mason, NP Interstitial Lung Disease Clinical Coordinator
Overview • Building a Budget • Communication • With the sponsor • With the Department of Finance • With your Division and Grants & Contracts • Day to Day • Reconciliation • Annual invoices
Building a Budget • Money Money Money Money Money Money • Your Budget • Create your own system • Use the Department of Finance Website
CPT Code and Price List Example: CPT Code CDM Descriptor Cost D&H_______ 94720 28010031 Diffusing capacity $317.00 $136.00 94240 28010056 TLC $389.00 $124.48 94060 28010098 pre-post bronchodilator $622.00 $199.04 On and on and on… Last updated: 2/02/2007
Creating your own Budget Standard of Care Study D&H Cost Procedure # each total # each total # each total_ Screen Physical (1) $ 450 $ 450 (1) $450 $ 450 PE (9) $ 150 $1350 (9) $150 $1350 Facility Fees (9) $ 204 $1836 (9) $200 $1800 (9) $ 44 $ 403 HRCT (1) $1749 $1749 (1) $1550 $1550 (1) $384 $ 384 PFTs (9) $ 727 $6543 (9) $ 350 $3150 (9) $159 $1439 etc. etc. Formulas for percent effort (Kathy to discuss) Don’t forget overhead! Totals: $ 16244 $ 12000 $ 4900
Communication With the Sponsor… As you are all aware, many times the budget that the sponsor provides is rather weak. Negotiate with them! They have money! They usually have a “top” amount that they are not supposed to go over, and the amount that they provide at the beginning, is not it. Not every study may be fruitful… but you need to be sure that you are not putting your center in the red.
Communication With the Department of Finance Website: http://finweb.mc.vanderbilt.edu/index.asp Technical Charges • Alison Culley, Dianne R. McGrath • Office 322-0200, Fax 936-6851 D&H Charges (Technical) • Nancy B. Stanley Professional Charges (VMG) • Judy Cooper, Cindy Charvis, Lee Ann Buck
Communication With the Department of Finance Required Forms: • Project Information Page • Clinical Research Budget Grid • Clinical Trials Registration Form • Transmittal Form (All forms are located on their website)
Communication With the Department of Finance “Please be patient.” “Be timely.” “Review billings carefully.” “Look for trends in errors.” “We are here for you.”
Communication With your Division/Department and With Grants and Contracts Complete your required paperwork for the Department of Finance and submit this with your Contract to your contact person within your Division/Department. Communicate with these people regularly to ensure that your project is not getting buried. Grants and Contracts • Janet Fry
Communication Know the Language BUILD 3 060963692-8000 404-383-7485 AC-052-321 ACTELION LANCASTER 070049
Day to Day • Prevent billing errors before they happen. • In scheduling patients, ensure that they are scheduled to be billed to the appropriate account. • Ensure use of the Clinical Trial ICD9s: • V70 – standard of care • V60 – D&H • Review every billing sheet you are able to see: • Lab orders • Radiology • Encounter forms
Reconciliation More than one way… • Financial Statements • E-Dog (Kathy Price) Monthly I receive: Financial Statements Technical Charges Professional Charges
Reconciliation Carefully review the Monthly billing sheet from the Technical side and the Claim Form from the Professional side. Correct patient? Correct procedure? Correct D&H?
What to do with Errors • Patient states that their bill is wrong • Have them send you the bill, verify error, then contact appropriate entity. • Professional fees: • Contact Lee Ann Buck, 6-0515 • Provide medical record, date of service, and the charge and why it is incorrect. • Technical charges: • Fax the monthly statement to Alison/Dianne at 6-6851 • circle the error and briefly explain the problem.
Invoices • Consider doing this annually with your continuing review. • Ensure your invoice includes the correct center number and remittance address. • This can be quite a bit of money! • IRB fees • Pharmacy fees • Screen Failures • Patient payments • Anything that you previously discussed in your contract