Medicare Coverage Analysis

The Clinical Trials Office (CTO) is responsible for performing a Coverage Analysis on all Human Subjects Research studies submitted.

Coverage Analysis is a process in which a research site determines who will be paying for each of the protocol-required item, service, and activity. For most industry-sponsored studies, each item, service, or activity is assigned a billing designation of either Pure Research (i.e., paid for or reimbursed by the sponsor) or Routine Care (i.e., proven to be a covered service of Medicare).

Upon determining these designations, a billing plan can be developed and the budget negotiation with the sponsor can begin. The coverage analysis determinations are built and documented in OnCore and Epic, as applicable.