A framework for workflow-based clinical research billing disambiguation.

Area of Science:

• Health economics
• Clinical research administration
• Health informatics

Background:

• Medicare gained authorization in 2000 to cover routine costs for clinical research participants.
• Accurate differentiation between standard and investigational care is challenging, potentially leading to under-coding.
• Under-coding results in missed reimbursement opportunities for clinical events.

Purpose of the Study:

• To address the problem of under-coding in clinical research reimbursement.
• To develop a methodology for creating computational clinical workflow models.
• To aid in disambiguating routine versus research costs for Medicare reimbursement.

Main Methods:

• Initiated the development of a novel methodology.
• Focusing on constructing computational clinical workflow models.
• These models aim to differentiate standard of care from investigational care.

Main Results:

• Methodology development is underway.
• Computational models are being constructed.
• The approach is designed to aid in cost disambiguation.

Conclusions:

• A new methodology is being developed to tackle under-coding in clinical research billing.
• Computational workflow models show promise in distinguishing routine from research-related costs.
• This approach could improve accuracy in Medicare reimbursement for clinical research.