Q&A: Managing edits on clinical trial claims

Q: Our clinical trial claims often hit edits for missing drugs or devices when those are supplied by the trial sponsor and we can't bill for them. We've been manually reviewing these edits. Is there a recommended method for handling these types of edits that's more efficient?

A: In the realm of clinical trials, there are many times when devices or drugs may not be found on the claim because they are provided by the sponsor and therefore cannot be billed. In these cases, the claim without the drug or device charge would be correct, but the system may read it as an error and therefore not release the claim. This scenario is common for clinical trials where there are often edits that have to be manually reviewed and released. One common workaround to prevent that edit from firing and allow the system to release the claim is to place a $1 charge for the device or drug on the claim so that it will go through even though the sponsor provided the item. In general, the $1 claim does not pay, but it does allow the claim to pass this particular edit and continue moving through the revenue cycle.

For more information see The Practical Guide to Clinical Trials Billing.