Clinical Research Billing Support Team

The Clinical Research Billing Support Team (CRBS) completes a Medicare Coverage Analysis (MCA) for clinical trials taking place at Washington University. The documentation of the MCA was previously done in the Billing Matrix system but has transitioned to using the Coverage Analysis Console in OnCore with the Enterprise-wide implementation of OnCore in 2019-2020.

The Coverage Analysis Console in OnCore provides tools to:

• Document Qualifying Clinical Trial (QCT) determination
• Record the logic/rationale used to determine whether the study is a Qualifying Clinical Trial (QCT) according to Medicare rules
• Record billing information for each procedure, such as:
  • Billing designations, which indicate how the costs will be covered for the trial (such as Bill to Sponsor, Bill to Patient/Insurance, or Not Billable).
  • Supporting designations, which are designations used by the CRBS team to add needed  details for Research services or document the reason  the service can be billed to Medicare/Insurance, according to Medicare’s Clinical Trial Policy.
  • Billing modifiers (Q1 or Q0), which indicate to Medicare and other insurers whether the procedure is a routine service or an investigational clinical service related to the trial or investigational device.
• View the Billing Grid – a calendar view of all scheduled procedures and their respective designations.

CRBS Team:

Administrative Staff:  Cheryl Thomas, Jaleh Taylor and Kim Gal

Coverage Analysts: Vickey Harper (Supervisor), Catherine Hartmann, Ariana Travis, Diane Clemens, Tina Hicks, Tammy Roussey, and Kayla Walker

Manager: Kelly Granda