Medicare Coverage Analysis

Clinical Trial CoverageA Medicare Coverage Analysis is required for all research studies. The Medicare Coverage Analysis must be performed prior to enrolling study subjects and initiating clinical research procedures. The purpose for the Medicare Coverage Analysis is to determine what routine costs of a clinical trial can be billed to Medicare and what costs a sponsor must provide funding for.  This process makes sure there is funding for procedures ensuring Aurora’s revenue is maximized. 

In order to bill Medicare for routine care costs of items and services, a clinical trial must meet certain criteria to qualify for reimbursement. The team will determine whether your clinical trial meets the requirements for reimbursement by Medicare for routine costs. The completed Medicare Coverage Analysis is given to one of Aurora’s Research Business Operations Specialists to aid them in preparing and negotiating budgets. 

A Medicare Coverage Analysis helps:

  • Investigators determining the financial feasibility of a proposed study. 
  • Investigator Initiated Researchers develop a study budget.
  • Ensure accurate and compliant billing by providing documentation to verify that research driven procedures are billed to the appropriate party
  • Protects potential research subjects as it informs them, as it is reflected in the informed consent process, as to their potential financial liability as a result of participating in a study. 

Aurora will charge industry sponsors a fee for preparation of the Medicare Coverage Analysis. 

While the Medicare Coverage Analysis only looks at Medicare Billing regulations, all subjects in a study are billed consistently as if they were a Medicare Beneficiary.