This presentation delves into the complexities of managing DRG impacts and ICD-10 procedure coding in clinical trial billing. Key focus areas include identifying billing errors that may go unnoticed, understanding the implications of overpayments, and addressing communication gaps between teams. The session will explore UB-04 billing, crosswalking CPT to ICD-10 codes, and handling both inpatient and outpatient scenarios. Attendees will gain insights into real-world challenges, such as when a sponsor only pays for room and board, and strategies for managing outlier DRG hits. Through practical scenarios and actionable strategies, participants will learn how to safeguard compliance and enhance operational efficiency.

Objectives:

1. Identify potential risks and challenges associated with ICD-10 procedure code usage and its impact on Diagnosis-Related Groups (DRGs).
2. Outline effective communication strategies between clinical trial teams, inpatient (IP) coders, and billing departments.
3. Discuss scenarios where clinical trial billing intersects with DRG-related reimbursement, highlighting risks such as overpayments.
4. Demonstrate how to crosswalk CPT codes with ICD-10 codes inpatient billing.
5. Provide practical solutions for avoiding common pitfalls in clinical trial billing compliance, especially when sponsors cover partial costs.