[OCRcommunications] Update-Guidance for the comments section to improve handling of IDR corrections

[OCR]

The following guidance is for the comments section to improve handling of IDR corrections.

If the DoS on the invoice is NOT study related, please indicate since RC will be released without any modifiers, NCT numbers and Z codes.

Each research related visit charge can have three outcomes:
a)           Research related - sponsor paid
b)           Research related - insurance paid
c)           Not research related charge (though happened to occur on a research visit day or during the research encounter.
Ex: Patient consulted with a surgeon, on the same day as the research visit which has nothing to do with the study. Or Patient went to ED on the evening of the research visit and had an ECG again.

Typically, if DoS is study-related, Revenue cycle will use CTCA to assign charges (sponsor vs. insurance).
Hence, please ensure the 'encounter' is linked to the EPIC research calendar, not just at the order level.

If the encounter is linked, if you see a mistake in assignment of charges to sponsor vs. insurance, even after verifying per CTCA, please specify which ones are incorrect, add some helpful comments as listed below.

Comments that are helpful (section is green is the action that RC can take based on the comments):
*            Contrast is included in MRI charge and should not be billed separately. (RC can adjust bundle pricing)
*            Monoclonal antibody is provided by the sponsor and should not be billed.(RC can charge correct the antibody pricing to a penny charge or at least work through the source to have it corrected)
*            Scans (CPT 71260, 74177, 70491) should be billed SOC, Calendar linking was corrected. (at least RC can review the schedule of events to the linked date and assign per CTCA).
*            Invoice has incorrect unit prices for all CPT codes per SOA with Children's (RC can check the Children's SOA in Velos and update pricing)

Comments that are ambiguous, not immediately helpful and may get more questions:

"This should not be billed to research" -Why? Is this incorrect per CTCA, revenue cycle mistake? Or CTCA is incorrect? Or not study-related to visit?

1.           "PI says this is SoC"
2.           "this is standard of care or routine care".
3.           "this should be billed to routine care."
4.           "this is not research expense and should be billed to standard of care"
5.           "CT abdomen is patient pay"
All four cases above, Is this study related standard of care or not-study related standard of care? Please remember, billing process slightly differs for these two scenarios, though they are billed to insurance. This distinction is very critical for Medicare billing. Patient may receive same services as someone who is not on the study, but when we bill, it may be necessary to include NCT number and other modifiers since the patient is on a qualifying clinical trial. Hence, specifics are important.


Office of Clinical Research Administration
McDermott Building-3rd Floor.
5323 Harry Hines Blvd.
Dallas, Texas 75390
OCR at utsouthwestern.edu


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