“how do i access hospital services for a study? office of clinical investigative services human...

“How do I Access Hospital Services for a Study?

Office of Clinical Investigative ServicesHuman Research University

November 2013

OCIS 706-721-6247 www.gru.edu/OCIS 1

Goal: Participants will be able to schedule a study patient for a hospital service.ObjectivesParticipants will be able to:1.Define basic clinical trial terms and concepts. “The Foundation”2.Define the elements needed to set-up a study to access hospital services accurately. “The Preparation” 3.Schedule visits and procedures and process hospital invoices. “The Process”


Goal and Objectives

Georgia Regents University“campus side”

Georgia Regents Medical Center“the Hospital”, “MCG Health Inc”

Children’s Hospital of GeorgiaChildren’s Medical Center

PPG (Physician’s Practice Group)Georgia Regents Medical Associates


“The Foundation”

PeopleSoftGRU Financial System

HealthQuestHospital Financial System

IDXPatient Scheduling System

Visits and ProceduresOCIS 706-721-6247 www.gru.edu/OCIS 4


PowerChartElectronic Medical Record

PowerTrialsHospital Clinical Trial Management System

MRN Medical Record Number



Two Types of Bills

Hospital facility fees –Pt. Accounting

Physician professional fees -PPG



Charge MasterList of hospital pricesAvailable thru OCIS

Clinical Research Discount60% on Hospital charges

92% on labs (except send-outs)

PPG fees Available from OCIS



The Payer“Study/Research Plan”

The Guarantor The CPI # assigned to study



CPI Corporate Person Index

Account number assigned to study by hospital“Dummy Account”

Encounter Form

Used to bill for outpatient charges

UB-04 Electronic inpatient claim form



Study Payment Models

Study pays for everything

“Carve Out”- Routine Care billed to insurance. Study pays for study-related expenses

Medicare Qualified studies



May bill to Medicare/Insurance

If all of the following criteria are met Qualified study Medically reasonable and necessary Sponsor is not paying for it Medicare covers it for all beneficiaries Approved study billing grid

See Medicare Qualification Form on OCIS website



Radiology Services

See Radiology Form & Instructions on OCIS

website Remember physician professional fee


“The Preparation”

Hospital Pathology Department - Clinical Pathology - Body fluids

Hospital Pathology Services - Anatomical Pathology

- Tissue samples

See Pathology Form & Instructions on OCIS website



Final elements Fully executed contract

Study entered in PowerTrials by OCIS

Receive CPI# and labels from OCIS



Study stickers from OCIS: Rm BB 8514



Study Label

VISIT GUARANTOR: CPI# 002352898 PI: McGraw, Phil M.D.STUDY INFO: HAC# Pro000076 Contact: O. WinfreyBILL TO: STUDY/RESEACH PLAN Ext. 1-Hollywood IDX FSC 54/ IDX PLAN S007

To schedule a study clinic visit –all procedures billed to study

1. Patient entered in PT by the site2. Call Central Scheduling: ext. 1-22733. Provide patient info (SS#, MRN, DOB)4. Reason for Visit/Chief Complaint:

“Study”4. The Payer: Study/Research Plan 5. Visit Guarantor: CPI#


“ The Process”

Patient ArrivalPatient arrives at clinicFront Desk “arrives patient” in IDXEncounter Form is generatedPlace green study label in upper left cornerEF contains study procedures ONLY


“The Process”

A second visit must be scheduled in IDX

A second encounter form needs to be generated

Second encounter form - Green study label goes on upper left hand corner

Check the procedure(s) to be billed to study. Physician signs Encounter Form


“The Process” Routine Clinic Visit with Study Procedure(s)

To orderOrder is written in PowerChart. Indicate “bill to study” Provide CPI#. MD “fires” the orderSend hard copy via order.comTo scheduleStandard procedures call: 1-2273Specialized procedures: 1-9729 Payer is “Study/Research Plan”Policy Number is CPI#. Guarantor is Study CPI # Call Radiology to verify OCIS 706-721-6247 www.gru.edu/OCIS 19

“The Process” Radiology Procedure to be Billed to Study

If there is a corresponding clinic visitOrder written in PowerChart.Indicate “bill to study”. Provide study CPI#Put green study label on tube

If no clinic visit Call Central Scheduling 1-2273 You need a “lab only” visit created in IDXProvide study CPI#Put green study label on tube and paperwork

If after hours: at lab, ask for “down time” label be put on tube. Provide study CPI#.


“The Process”

Lab to be billed to Study

If study pays for everything Admitting physician submits the

Advance Directive States everything is to be billed to

study Work with Hospital Patient Access

Services Extension 1-2561


“The Process”

Inpatient Study Stay

If some items are to be billed to studyCheryl Egan

[email protected] (ext.1-7267)

Provide following information Patient name/medical record number Study CPI number Item(s) to be billed to study


“The Process”

Inpatient Study

Indicate study visit # (cycle # and day if applicable)

Indicate if unscheduled visit or adverse event treatment

Submit to HMS HMS scans to the Clinical Trials section

of the chart Check in chart to see that its in the

correct location

Research Progress Note


How to handle a correct billStudy contact receives billBill is verifiedCheck request generated Payment due within 30 days of service Authorization to Budget


“The Process”

Study contact receives bill Bill is inaccurateEmail Cheryl Egan (extension 1-7267) Pt. name and date of service Study Name. Visit# (Cycle and Day if

applicable) Explanation of the requested changes If correction needed a revised claim will be

sent Pay from revised claimOCIS 706-721-6247 www.gru.edu/OCIS 25

“The Process”

How to handle an incorrect biil


“Homeward Leg”

CRITICAL for study close-out

Verify any outstanding bills with Patient Accounting

Change study status in PowerTrials

Questions???


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