New service assists investigators in determining insurance coverage for industry-sponsored studies

On November 18, Stanford Health Care (SHC) implemented a new, enhanced “Coverage Analysis” process to ensure that clinical services rendered by SHC in industry-sponsored clinical trials are accurately charged to either patient insurance or to the study account.

Stanford Health Care has hired external experts, Ankura Consulting, to conduct these coverage analyses. Their analysts are well versed in Local and National Coverage Determinations (called LCDs and NCDs), Medicare/Medicaid rules, and clinical practice guidelines. They will work directly with study teams, the Research Management Group (RMG), the Cancer Clinical Trials Office (CCTO), and Patient Financial Services (PFS) to complete each analysis.

Benefits of this new service include:

  • Facilitating realistic study budgeting
  • Optimizing use of study funding and mitigating the risks of errors associated with the ever-changing insurance reimbursement landscape
  • Reducing billing errors
  • Saving staff time

 

Beginning November 18, Ankura will perform coverage analyses for all NEW industry-sponsored studies with clinical services rendered at SHC, including at Stanford’s Clinical Trials Research Unit (CTRU). Studies with services conducted at Stanford Children’s Health will be rolled into the Coverage Analysis process at a later date. Principal investigators will retain the ultimate authority and responsibility for the approval of final coverage analyses.

For details on the new process visit the resources page here.

For questions: StanfordCAIntake@ankura.com