Page 320 - CHST Research Administration eBook 2 of 2 (Q4 2021)

STANDARD OPERATING PROCEDURE Research Administration SOP No: R109 SOP Title: EPIC Billing Compliance
5. 5.1
Tracking of the training plan is important to ensure that EPIC billing compliance is successfully achieved. After each study team member completes EPIC billing training, the training date will be entered into the tracker and compliance toward successfully managing all research related charges will be internally reviewed as research opportunity permits. Compliance will be evaluated across five competencies, which will collectively determine the composite compliance score that will be reported to the Research Administration (RA) Leadership.
The goal is to have all study team members performing at 100% compliance ensuring that all study team members accurately; 1) Register the patients in Velos, 2) Schedule a “Research Coordination” Encounter, 3) Associate all orders to “Research Association”, 4) Associate all research related orders to a research diagnosis “clinical trial participant [z00.6], and 5) Enter all CPT and Emergency & Management charges. All those who perform below 95% compliance collectively across these five core competencies will be evaluated for retraining and subject to follow-up communication regarding retraining opportunities and expectations as part of an action plan.
SPECIFIC PROCEDURE EPIC Billing Compliance
Pre-Requisites: Successful management of EPIC billing is contingent upon completion of three key pre-requisites including the following:
• Ensure to obtain all study approvals including Institutional Review Board (IRB) and Performance Site Approval (PSA) (see CP 7.06 Initiation of Research).
• Ensure to obtain a fully executed study budget (i.e., service order agreement [SOA]) and clinical trial agreement (CTA).
• Initiate a Hospital Accounting Record (HAR) for the study.
• Provide Creating Research Encounters (see attached) to ensure that on site Research Encounters on site are set-up with the payor as the guarantor, and select no bill, no copay scheduling options for research only visits.
EPIC Billing Compliance: Once all pre-requisites have been met and the study is activated, all research related charges including non-medical, current procedural terminology (CPT) and evaluation and management (E&M) charges, must be entered into the Patient’s Accounting record or onto to the study HAR as appropriate.
5.1.1 Register: the patient in Velos (for further guidance, please see SOP D027 Velos Study Status and Study Enrolment). Ensure that the patient shows as Research Active in their medical record.
5.1.2 Schedule: a Research Coordination encounter type:
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