Clinical Trial Billing & Coverage Analysis Scrubber
Double-billing Medicare for research items funded by study sponsors creates severe False Claims Act exposure. Build compliant clinical trial coverage analysis matrices, validate 8-digit NCT identifiers, and sequence Modifiers Q1 and Q0 correctly on ANSI X12 837P claims.
Clinical Trial Billing & Coverage Analysis Scrubber
Separate Medicare-covered routine costs from sponsor-funded investigational items under CMS National Coverage Determination 310.1. Validate 8-digit NCT numbers, verify Modifier Q1/Q0 compliance, and prevent False Claims Act double-billing recoupments.
1. Trial Protocol Parameters
Field 19 / Loop 2300 REF*P4 requires exact 8-digit NCT format.
ICD-10 Z00.6
Encounter for examination of normal comparison and control in clinical research program.
2. Select Clinical Trial Protocol Services
Check procedures administered during the clinical trial study visit.
Covered by Medicare as reasonable and necessary routine clinical care. Must append Modifier Q1 and include diagnosis Z00.6.
Covered by Medicare as reasonable and necessary routine clinical care. Must append Modifier Q1 and include diagnosis Z00.6.
Covered by Medicare as reasonable and necessary routine clinical care. Must append Modifier Q1 and include diagnosis Z00.6.
Research-only biopsies, investigational drugs, and protocol visits cannot be billed to Medicare. Double billing violates the False Claims Act.
Research-only biopsies, investigational drugs, and protocol visits cannot be billed to Medicare. Double billing violates the False Claims Act.
Schedule a Clinical Trial Coverage Analysis (CTCA) & Billing Audit
Our certified clinical research billing specialists review your study protocol, develop compliant coverage analysis matrices, and eliminate False Claims Act double-billing risks.
Turn these Clinical Trial Billing Scrubber insights into recovered cash
Managing complex clinical trials or IDE device studies? Aethera's specialized clinical research revenue cycle team performs Coverage Analyses (CTCA), validates NCT numbers in Loop 2300 REF*P4, and ensures zero False Claims Act double-billing risk. Let our senior AAPC-certified billing team audit 50 of your active claims or past denials — completely free, with guaranteed under-48-hour findings.
Test our scrub rules and appeal workflow on 50 real claims. Zero commitment, no credit card required.
Upload your aging report for instant benchmark comparisons against MGMA standards and recoverable cash projections.