With the start of a new fiscal year, there are important steps you need to take to build a successful clinical trial billing compliance program. The following information will help you develop procedures for handling any reimbursement issues that arise.
Evaluate Your Current State
When developing an effective compliance program, you’ll need to establish a good coverage analysis process and determine the project revenue cycle. You also need to determine where your workload, research, and billing funds are allocated, so you can easily find any unnecessary or redundant expenditures. You’ll be able to develop a more solid financial management plan if you clearly know where all your billable costs are allocated. It will also be easier to track the flow of funds and reallocate unused money to other areas of your organization.
Assess Your Operational Policies
The first step in any good billing compliance program is researching coverage analysis. It is crucial that your operational policies are in place and up to date. That way everyone involved will have consistent and identical information regarding updates. To help you stay on track, here are seven guidelines to develop an effective compliance program:
- Have well-written policies and procedures in place.
- Appoint compliance officers and a compliance committee.
- Provide training and education.
- Have effective lines of communication.
- Use internal auditing and monitoring practices.
- Enforce standards with well-publicized disciplinary guidelines.
- Respond promptly to problems and take corrective actions.
Manage Trial Information
In order to manage trail information effectively, you need understand what your system can do so you can identify how to have effective billing and payment processes. If your business has multiple billing systems, this process can become complicated, particularly if you do not have electronic tracking capabilities for your patients. Understanding how billing is done is a key component to ensure compliance.
Inventory IT Systems
If you are running multiple IT systems, they need to communicate with each other, particularly if some of the systems are older and not as technologically advanced.
You’ll also need to be knowledgeable about the systems that you use; understand how they can help or hinder your claims processing and act accordingly. Regardless of the system you have, it’s only as good as the data in it, but some key tools can help you better manage this information and the flow of fund throughout your project.:
Using a CTMS will enhance your patient management, financial management, and billing compliance management processes.
- Claim Scrubber
Claim Scrubber will validate and assist you with the claim submission process.
The EMR will help you track patient data over an extended period of time.
Knowing how these systems engage with your data and each other will help you manage workflow, increase productivity, maximize revenue, and mitigate risk.
To get more information on creating a successful billing compliance program, take a look at our latest webinar, Creating a Successful Billing Compliance Program for 2019.