Research Registration and Billing

1
Research Registration and Billing

• One Institutions Experience
• Cincinnati Childrens Medical Center
• Presenter Andrea L. Smith
• Andrea.smith_at_cchmc.org

2
Research Registration and Billing

• Overview
• Old Process
• New Process
• Nuts and Bolts Basics
• Registration Steps
• The Study Invoice
• Important Tips to Get Started

3
What Started It All

• One Case in 2001
• Insurance Billed In Error
• Insurance Reimbursed
• Consequences

4
Overview

• History
• Initial meeting September 25, 2001
• Intra-disciplinary Committee formed
• Process mapped
• Process redesign
• Administration support and buy-in

5
Overview
Functions Represented

• Laboratory
• Patient Financial
• Services
• Pharmacy
• Regulatory Affairs
• Research
• Administration
• HIPAA, Legal Offices

• Accounting
• Admitting/Registration
• Clinical Research Center
• Clinical Trials Office
• Divisional Reps
• Health Info Mgmt (HIM)
• Information Services

6
Overview

• Objectives
• To increase research subject safety
• To comply with accreditation and regulatory
  agencies
• To develop efficient and standardized
  administrative research processes
• To serve as a data source

7
Overview

• Objectives
• To provide a formal infrastructure for scheduling
  and registration of research subjects
• To ensure timely and proper billing
• To establish consistent and standardized charges
  for research procedures

8
Overview

• The Need for Change
• The current process is not understood by
  researchers and not documented (tribal legend)
• Most research outpatients not registered in any
  hospital system under own name.

9
Overview

• Old Process
• Obtain patient account number from Hospital
  Laboratory for study.
• Registrars have to remember to code research
  visits x10 for inpatient or x70 for
  outpatients.
• No standardized information about how to set up a
  research study or put subjects through
  administrative pipeline available.
• Bills do not have participant-specific
  information.

10
New Process
11
New Process

• Obstacles
• Investigators/Faculty You are telling us how
  to do our research.
• Study Coordinators You are telling us to do
  more duties on top of all the other things.
• Finance personnel We are not going to change
  our system for research low volume, going great
  as it is.
• Older systems for registration, billing built
  for the clinical world.

12
Outpatient Research Subjects

• A subject enrolled in a research study who is
  physically seen on any CCHMC property, or has a
  test performed on any CCHMC property.
• Clinical inpatients who are simultaneously
  involved in a research study will also be
  registered as an outpatient for research
  procedures.

13
Overview

• Roles and responsibilities
• Principal Investigators
• Study Coordinators
• Billing Coordinators
• Registration Personnel
• Lead Administrators

14
Research Registration Process
1 2 3 4
Research Study Approved
USF Form Processed
656 Number Assigned
Study Coordinator Schedules Visit
Study Coordinator Pre-Registers Study Subject
Registrar Activates Account
Study Subject Presents for Visit
Study Subject Receives Service
Billing Enters Charges

Charges Electronically Passed to Bill
15
(No Transcript)
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USF provides important data

• Funding Source
• ? Federal/ Non-Profit (Fee schedule 1)
• ? Industry (Fee schedule 2)
• Divisional/ Institutional (Fee schedule 2)
• The funding source determines which fee
  schedule or discount will be used.

17
Scheduling Information

• Research Registration will not require that you
  change your current scheduling system.
• Main objective is to ensure scheduling
  information is communicated to the person
  responsible for activating outpatient
  registration.

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The Basics

• All research subjects will be registered with a 4
  million patient account number (a unique series)
• Once the USF form has been completed, a 656
  guarantor number (similar to insurance guarantor
  numbers) will be issued for each funding source.

19
The Basics

• The hospital service code for all research visits
  will be RSH or RSS for satellite clinics
• The clinic code for all visits will be the same
  as the clinic code for medical visits (area of
  service)
• The diagnosis code will be V70.7 for all research
  visits.

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Registration Steps

• Pre-registration (Study Coordinator)
• Account Activation (Clinic or Treatment Center
  personnel)

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Registration Master Menu Screen
Admit Supervisor Master
Menu 11/26/03 1506

-----------------------------
--------------------------------------------------
-
INQUIRIES
PRINT OPTIONS
! 01 EAD Inquiry
! 20 Print Reports !
02 Numeric Inquiry
! 03 Inhouse Patient
Name Inquiry
! 04 Phonetic Inquiry


CENSUS INQUIRIES

! 10 Nurse Station Census (Occ Beds)
MISCELLANEOUS OPTIONS ! 11 Nurse
Station Census (All Beds) ! 30 Post Bed
Status ! 12 Nurse Stations At A
Glance ! 31 Misc Menu
! 13 Supercensus (1 line)
! 32 Trauma Stat/Alert or Med Resus ! 14
Supercensus (Active File) ! 33
Scheduling ! 15 List Beds
For Nurse Station ! 34 Scheduling
Maintenance ! 16 Care Provider Census
! 35 Insurance Eligibility
! 17 Display Temporary Patients !
36 Message Mailbox
-------------------------------------------------
------------------------------- OPD1 SP06
(LU) Enter
__ Press Enter ! PF11 Signoff

22
Registration Process
Admit Supervisor Register/Admit
Options 11/26/03 1451
F / Pt
Atn Dr
Adm Dt
Isol
Mr -----------------------------
--------------------------------------------------
- INPATIENT OPTIONS
OUTPATIENT OPTIONS ! 01 Admit
Patient ! 20
Register Outpatient ! 02 Preadmit
Patient ! 21 Preregister
Outpatient ! 03 Admit Preadmitted
Patient ! 22 Enter Temporary
Patient ! 04 Admit Temporary Patient
! 23 Register Insurance Ref Pt
! 05 Quick Admit
! 26 Register Preregistered Patient
! 27 Verify
Temporary Patient
EMERGENCY OPTIONS
MISCELLANEOUS
! 30 Enter Emergency Patient ! 10
SEND REG TO PBS ! 31
Quick ER

! 11 Research Registration Options
! 32 Verify Emergency Patient

---------------------------
--------------------------------------------------
--- ! PF13 Master Menu
Enter __ Press Enter ! PF14
Submenu
! PF11 Signoff
23
Registration Process
Research Coordinator Submenu
11/26/03 1516 BLACKSHEEP ,BABA
F 2 / RSH Pt
400001590 Atn Dr GRUPPO, RALPH A.,
Adm Dt
11/26/03 OA Isol
Mr 1002874 --------------------------
--------------------------------------------------
--- RESEARCH REGISTRATION ONLY
PT LOCATION OPTIONS
INPATIENT/EXTENDED STAY ! 30
Transfer Patient ! 01 Research
Preadmit ! 31 Outpatient Bed Menu
! 02 Upgrade Preadmit
! 32 Discharge Patient
! 03 Research Admit
! 33 Census History




RESEARCH
OUTPATIENT
! 10 Research OP Prereg
MISCELLANEOUS OPTIONS
! 11 Research Upgrade Prereg
! 40 Review Patient Information !
12 Research OP Registration
! 41 Regenerate Documents
! 42 Research Charges




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Research Registration Process
11/26/03 0809 RESEARCH
REGISTRATIONS-----OUTPATIENT ONLY


PATIENT NAME
MEDICAL RECORD NUMBER
-------------------------------
-----------------------------------------------
LAST NAME BLACKSHEEP FIRST NAME
BABA MI _ ADDRESS
______________________ ZIP _____- ____
COUNTY ___
______________________ CITY
_________________ ST __
GUAR/STUDY ________ GUAR NAME
_____________________ SEX/MAR ST
F _ BIRTHDATE __/__ /____
REG DATE __ /__ /__ REG TIME __
/__ HOSP SERV RSH
PT RACE _ CLINIC CODE ___
PRIMARY INVESTIGATOR ______
PI NAME __________________
HPAA _ DIRECTORY _ HOME PHONE ___
- ___ -____ DX V70.7__

MEDICAL RECORD NUMBER
________ LEAVE FIELD BLANK FOR AUTO ASSIGN
PATIENT NUMBER ____________

COMMENTS ______________________
__________________________
--------------------------------------------------
--------------------------
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Combined Clinic and Research Visits

• Subjects may be seen in a Clinic for two
  purposes Clinical (ENT regular follow up visit)
  and as part of a research protocol (in ENT or
  another clinic).
• For these patients/subjects two types of records
  will be generated. One record for the regular
  clinic visit and a second record for the research
  protocol. Each must be labeled correctly and
  forwarded to the appropriate location (clinic
  visit to HIM and research visit to the PI).

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Where Will Outpatient Research Records be Stored?

• Records for research subjects seen at any CCHMC
  property in an outpatient setting (Clinic,
  Radiology, Lab, etc.) will be stored in the
  Outpatient Research Record in the Principal
  Investigators office.

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Outpatient Research Identification

• When the research subject registers, a set of
  labels will be generated (or an addressograph
  plate will generate). The first line will
  identify the patient as a Research Subject
• RESEARCH OUTPT
  RESEARCH OAK
• DOO ,SCOOBY X
  DOO,SCOOBY X
• 13Y 9 M RSH 04/12/90
  13Y 9M RSO 041290
• 400001764 M 99999999
  400001764 M 99999999
• CIAMBARELLA, E 000111
  CIAMBARELLA, E 00011
• 011204
  011204
• Documentation labeled as such must be forwarded
  to the principal investigator listed on the
  addressograph/label.

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Sensitive Research

• In the case of research subjects enrolled in
  sensitive research, the Sensitive Research form
  will be forwarded to the HIM Department in lieu
  of the copy of the signed informed consent.

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HIM (Medical Records) Department Responsibility

• Based on information received on the USF form,
  the HIM Department will maintain a list of PIs,
  along with primary and secondary contacts for
  each Research Study.
• In the event an Outpatient Research Record is
  required for patient care, the HIM Department
  will contact the PI.

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What Reports will be Available?

• Total visits
• Total pre-registrations that are not activated
• Summarized by
• Study
• Location (Research Main and Research Oak)
• Clinic Code
• These are monthly reports.

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Audit Information

• Lead Administrators are responsible for
  designating a person (recommend this be the study
  coordinator) to complete the daily audit log to
  ensure research subjects pre-registered are
  consistent with research subjects registered.

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Audit Information

• The purpose of completing the daily audit log is
  to ensure accurate registration and APPROPRIATE
  billing.
• Incorrect billing may occur when
• Subjects are registered incorrectly as clinical
  patients
• Subjects that were seen for a research visit were
  not registered

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Billing

• Fee schedule tables in Patient Financial system
  discount the charges to the correct amount
• Bill (invoice created)

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The Study Bill
35
Billing

• Ability to pull billing information which resides
  on Finance server into your Access database
• Monitor expenses by comparing what was approved
  vs. what was billed.
• Query data and produce reports.

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Important Tips

• Pull together institutional representatives to
  discuss issues
• Get buy-in from faculty, senior management
• Map out current process
• Build case for changes (particularly those
  involving expense to institution)

37
Questions?