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/policies/administrative/uwhc/uwhc-wide/fiscal/213.policy

201506154

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UWHC,

Policies,Administrative,UWHC,UWHC-wide,Fiscal

UW Health Charges for Patients in Research Studies (2.13)

UW Health Charges for Patients in Research Studies (2.13) - Policies, Administrative, UWHC, UWHC-wide, Fiscal

2.13

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Administrative (Non-Clinical) Policy
Category:
 UWHC only (Hospital Administrative-entity wide)  UWMF only (entity wide)
 UWHC Departmental (indicate name)  UWMF Departmental (indicate name)
 UWHC and UWMF (shared)
Policy Title: UW Health Charges for Patients in Research Studies
Policy Number: 2.13
Effective Date: June 1, 2015
Chapter: Fiscal
Version: Revision
I. PURPOSE

To establish a UW Health billing policy and procedure for patients participating in research studies.
II. POLICY

Charges are posted for all services for all patients participating in research studies. (See Hospital
Administrative policy 2.12-Hospital Billing Policy). Charges may be posted to a study-specific group or
research account (confidential patients, animal research studies) or to patient personal/family accounts. A
requisition/External Work order to cover the charges for services provided to the patient participating in a
study must be issued prior to submission of charges. Hospital charges which are study related are moved
to the appropriate monthly research account and submitted to grant funds or clinical trial accounts for
reimbursement. Physician charges which are study related are reviewed prior to posting to the Research
account and submitted for reimbursement.

III. FORMS

Appropriate billing slip documents that are entered into UW Health imaging system.
Patient Informed Consent Form

IV. PROCEDURE
A. Internal Study Set Up Requests:
1. If the primary reason the service rendered is for research purposes and not immediate
patient care, research funds must be allocated to meet the costs incurred in providing the
services. If research funds are available, the research coordinator must follow the steps
described below in order to assure the patient and/or their insurance is not billed in error
for research related services.
2. The principal investigator must inform the patient prior to study participation of any
potential financial liability resulting from participation in the study via the Patient
Informed Consent Form. The Office of Clinical Trials and Research Billing Compliance
Coordinator are available to provide assistance on charging and billing issues for research
studies and to identify charges which may be incurred by the patient in the study but not
covered by the grant.

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3. Failure to follow this procedure will result in the appropriate Medical School department
or the principal investigator being assessed the charges associated with the services.
4. The study coordinator will submit a request to provide hospital services under a research
grant to the Office of Clinical Trials (“OCT”) via the Clinical Trials Management System
Oncore. OCT and the Research Billing Compliance Coordinator will review the budget,
assist with charge information and determine research year and tier (discount) if
appropriate. A discounted reimbursement agreement may be established for a period of
three years. Any exceptions would require review and approval by OCT and Compliance.
5. The department requesting the study services will send a completed Requisition to its
Dean's Office, which will forward a copy to the UWHC Patient Billing Office. A
completed External Work Order is sent to UWMF Special Billing Department.
6. Upon receipt of all of the necessary study information (i.e., internal work order, protocol,
study related services vs. standard of care, fund and account number), OCT will set the
study up in Health Link via the Oncore/Health Link interface. The Research Billing
Compliance Coordinator or Hospital Special Billing Account Representative will then
create a monthly recurring account in Health Link. This group/research account is valid
for this internal work order (study) only.
7. The study coordinator will document a patient’s status in Oncore (Clinical Trials
Management System). That information will interface with Health Link to show the
patients current study status. The interface between Oncore and Health Link will link the
patient to a research workflow in the hospital billing system which stops all billing to
insurance pending charge review. The (ADT) interface adds subjects and updates to
subjects status on studies in real time as data is changed in Oncore.
B. Hospital Charge Submission
1. Each patient who receives services will first be registered in accordance with approved
procedures. The patient's health insurance is captured and entered into the medical record
based patient account. If the patient is linked to a research study, workflows have been
designed to bring those study patients to the attention of a Special Billing Account
Representative so that charges can be reviewed prior to billing.
2. Charges for all services will be generated at the time services are rendered in accordance
with established billing practices. Charges must be applied within 1 day from date of
service. (See Hospital Administrative policy 2.12-Hospital Billing Policy).
a. Group Account: Hospital charge documents are identified with the group account
number and posted to the monthly recurring group account as appropriate
(confidential patients, animal research studies).
b. Personal/family Account: Hospital charges are billed on the patient's medical
record number based personal/family account.
3. Charges are posted to the patient's account through normal charge entry procedures. A
unique document – research billing slip (paper or via Oncore interface) - has been
established to identify services covered by research funding sources versus those services
that are standard of care. The purpose of the billing slip is to accurately identify charges
that are research related and move those charges from the personal family account to the
monthly research group account so that the research grant is billed for services covered
by the study and insurance or patient is billed only for services that are standard of care.
C. Physician Charge Submission
1. Each patient who receives services will first be registered in accordance with approved
procedures. The patient's health insurance is captured and entered into the medical record
based patient account. If the patient is linked to a research study, workflows have been
designed to bring those study patients to the attention of a Special Billing Account
Representative so that charges can be reviewed prior to billing.

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2. Charges for all services will be generated at the time services are rendered in accordance
with established billing practices. Charges must be applied 1 day from date of service.
a. Research Account: Physician charges that are identified as research are dropped
to a Research/Study Account type.
V. OTHER

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospital and
Clinics and the University of Wisconsin Medical Foundation, Inc. Each entity is responsible for
enforcement of this policy in relation to the facilities and programs that it operates.

VI. COORDINATION (the details of Coordination of UWHC and UWMF are shown below. Approval
and coordination of this policy by those entities is per their individual process.)

UWHC Sr. Management Sponsor: Chief Financial Officer
UWHC Author: VP, UW Health Patient Business Services; Director, Office of Clinical Trials

UWHC Approval Committee: Administrative Policy & Procedure Committee

UWMF Author: VP, UW Health Patient Business Services; Director, Office of Clinical Trials


SIGNED BY

Ronald Sliwinski
President & CEO

Revision Detail:

Previous revision: 092014
Next revision: 062018