Wiki Clinical Trial billing - Modifier Q1

[mletourneau@novocure.com]

Hello I am hoping to find someone with experience in billing clinical trials with Q1 modifier, for Medicare/MCA claims. We are trying to determine if the claims are to go directly to Medicare regardless if the patient has MCA plan? And if we do, does Medicare follow the 80/20 rule or do they pay in full for clinical trial cost? If they follow the 80/20 rule do we bill the MCA as secondary? Please advise appropriate billing avenue for clinical trial billing with Q1 modifier (routine care as part of clinical trial).

 

[sls314]

Hello I am hoping to find someone with experience in billing clinical trials with Q1 modifier, for Medicare/MCA claims. We are trying to determine if the claims are to go directly to Medicare regardless if the patient has MCA plan? And if we do, does Medicare follow the 80/20 rule or do they pay in full for clinical trial cost? If they follow the 80/20 rule do we bill the MCA as secondary? Please advise appropriate billing avenue for clinical trial billing with Q1 modifier (routine care as part of clinical trial).

Denise Quint is a great presenter on the topic of Clinical Trials. She presented on the subject at the Healthcon Regional in Philadelphia in 2024, and she also speaks regularly at chapter meetings.

Keep an eye out for any upcoming chapter meeting announcements where Denise is speaking. She also takes the time to do a Q&A at the end of her presentations as well.

(I know that doesn't specifically answer your question, but I wanted to at least make you aware of a potential resource.)

 

[mletourneau@novocure.com]

Thank you so much! I have not had an opportunity to join any chapter meetings in my area (Maine, NH) could you advise how I could locate any virtual meetings she may be presenting at?

 

[sls314]

Thank you so much! I have not had an opportunity to join any chapter meetings in my area (Maine, NH) could you advise how I could locate any virtual meetings she may be presenting at?

She actually lives in Maine, so she's in your neck of the woods!

Are you on LinkedIn? If so, send her a connection request. She typically shares on LinkedIn when she's scheduled to present to a chapter.

There are various Facebook groups where chapter meeting announcements are shared, which can be great sources of chapter meetings in general. But since you'd be looking specifically to see when Denise might be presenting about clinical trials, following her on LinkedIn would probably be helpful.

 

[sls314]

Almost forgot - she does share her LinkedIn profile and other contact information on her website: https://www.dq-compliance.com/

(Went back to look at the handouts from a presentation I saw her give, and she had her website listed on it.)