VCUH Notice: Clinical Research Billing

As most of you know, VCUH has recently implemented Patient Protocol Manager (PPM) to facilitate clinical research billing compliance.  We would like to thank you for your assistance in making this project a success.  However, during the implementation, we have identified a pattern where, in a significant number of cases, there is no documentation in Cerner stating that a clinical visit is associated with participation in a clinical trial. When this documentation is not available in the medical record, coding is unable to code the bills and the charges are held until we contact the provider requesting them to add a note (coders cannot access clinical research coordinator notes in Cerner.)  Thus, in order to reduce the number of emails and calls you and/or your staff receive about documentation, we are asking:

·         All providers to make sure to document in their Cerner note when a visit is associated with a clinical trial. 

·         To facilitate this process, we have created a Cerner template that can be pulled into your note.  You can access this template by typing ‘.zz’ and choosing the ‘clinical trial’ template. 

·         This template can be used in the following note types:

  • Out Patient New Initial Visit
  • Established Outpatient Visit
  • Surgery Procedure Note
  • Transitional Care Note
  • Clinical Trial Information

·         If the note is written by a staff member, the Physician-provider must verify the note.

If you have any concerns or questions, please contact Mary Harmon at 804-628-7819 or mary.harmon@vcuhealth.org.

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