Mixed vs. Non-Mixed Billing
Depending on the type of billing required by the study (research only, patient/insurance only or mixed billing) the FCA team will construct a budget in OnCore as follows:
Mixed Billing Studies
Mixed billing studies where any study encounters include a mix of patient care costs that will be split between a study account and patient/insurance will undergo full budget development. The study team will receive an itemized budget from the FCA team for review and to support sponsor negotiations, if applicable. The itemized budget will include CPT/HCPCS codes and corresponding research rates for study funded items/services, as well as research modifiers for Routine Costs billable to insurance and/or participants.
Non-Mixed Billing Studies
Non-mixed billing studies where either (1) all study subject encounters will be exclusively directed to either a research account; or (2) all study subject encounters will be exclusively directed to patient/insurance, will only receive full budget development from the FCA team when itemized sponsor invoicing is required. Otherwise, the study will be hardcoded in CareConnect, such that all study-associated encounters will drop to the study account or patient/insurance accordingly. If a study does not qualify for full budget development, the study will be created in OnCore without an itemized budget. Research faculty may request full budget development from the FCA team on a sales-and-service basis for non-mixed billing studies that do not require sponsor invoicing.
Please email CoverageAnalysis@mednet.ucla edu for more information.