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Clinical Research BillingOverview
Gina Vuocolo-Branch, DirectorCalendar Review & Analysis OfficeFall 2011
Executive Memorandum President Clinton signed an executive memorandum
on June 7, 2000 directing the Secretary of Health and Human Services to “explicitly authorize (Medicare) payment for routine patient care costs. . .and costs due to medical complications associated with participation in clinical trials”.
Source: CMS Transmittal AB-00-89
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Medicare Billing Requirements
Effective January 1, 2008, routine costs are reported to Medicare with modifiersQ0 - Investigational clinical service
provided in a clinical research study that is in an approved qualified trial
Q1 - Routine clinical service provided in a clinical research study that is in an approved qualified trial
Medicare Billing Requirements-cont’d
Diagnosis code V70.7 is required as a primary diagnosis for Inpatient (IP) and Outpatient (OP) clinical trials when the patient is a healthy control group volunteerThe study has diagnostic intent
Diagnosis code V70.7 is required as a secondary diagnosis for IP & OP clinical trials The study has therapeutic intent
Failure to bill Medicare appropriately may result in fraud investigation and/or treble damages.
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