Research Development Services (RDS) provides support for obtaining approval for use
of Augusta University Medical Center, Clinics, Ancillary Services, Medical Records,
and Patients (recruited from or using these services) that will be used during the
conduct of a research study.
RDS provides support for accessing the following hospital resources and services for
research purposes:
Using AU Medical Center facilities including hospitals and clinics for research visits
Liaison for AU Medical Center to establish processes for scheduling research visits
or procedures within AU Medical Center locations
Supporting research budget development through Medicare cost analysis, Coverage Analysis,
and prices for AU Medical Centers and AU Medical Associates
Requesting hospital services such as Radiology, Pathology, Clinical Research Pharmacy,
Tumor Bank, Blood Bank, etc., for research
Accessing data in the Electronic Medical Record (EMR) and within hospital databases
Chart Reviews: Indicate use of AU Medical Center resources on the IRBNet Core Data
form, then notify RDS at CTSRDS@augusta.edu including the following information: IRB number, study title, name of PI
Studies with billable hospital services are required to use OnCore.
A study with a billable hospital service will be assigned a code, known as the CPI
number. This is required for scheduling any hospital services.
Coverage Analysis
What is Coverage Analysis?
An analysis of a proposed clinical trial to determine which clinical procedures and/
or services can be billed to insurance and which cannot be billed to insurance
Helps identify financial liability of enrolled subjects
Provides true cost estimate to guide research budget development
Based on billing rules, not clinical intent
Demonstrates due diligence
Why do we need to complete a Coverage Analysis?
Mitigating risk
Facilitating billing compliance
Minimizing billing errors
Assist with better negotiation of sponsor budgets
Patient protection
What is needed to complete a Coverage Analysis?
Protocol
Informed Consent
If appropriate investigational drug/device brochures, case report forms, lab manuals
and other key documents
Draft clinical trial agreement and budget
Who decides what is covered?
Statutes
Centers for Medicare & Medicaid Services (CMS) makes a National Coverage Determination
(NCD) that sets policy for all contractors
Regional CMS Contractors make a Local Coverage Determination (LCD) that sets coverage
policy for all providers in that region.
Study clinic visit where visit and all procedures are billed to the study
Call Research Study Line at 6-5500
Provide patient info (MRN, DOB)
Reason for Visit/Chief Complaint: "Study"
The Payer: "Study/Research Plan"
The Guarantor: CPI# for the study
Routine clinic visit with study procedures
Call Research Study Line at 6-5500 and ask that a study visit be created
Inform scheduler as to the procedures to be billed to the study
If the study is paying for the lab, obtain the account number for lab (MRN + 4 digits)
to enter on Pathology Request Form
If no clinic visit but labs are needed
Call Research Study Line at 6-5500 and ask that a "lab only" visit be created
The Payer is the "Study/Research Plan"
The Guarantor is the Study CPI#
Obtain account number (MRN + 4 digits) to put on the Pathology Request Form
Ask Scheduler to "arrive" patient in the system
Submit tube(s) with Pathology Request Form If after hours, ask lab staff for "down time" label to be put on tube(s). Provide
study CPI#. Email Sandy Bragg atsabragg@augusta.edu.
Radiology procedure for billing to the study
Order is written in PowerChart
Enter in "Order Comments' tab "Bill to Study" and provide study CPI#
MD "fires" the order
To schedule, call Radiology at 1-9729, state what services are needed, Payer is "Study/Research
Plan," and the Guarantor is the study CPI#
Inpatient Study Stay, if study pays for everything
Admitting physician submits the Advance Directive
States everything is to be billed to the study
Inpatient Study Stay, if some items are to be billed to the study