{"product_id":"clinical-research-health-insurance-new-model-managing-medical-research-billing-preventing-insurance-9798994985212-new","title":"Clinical Research and Health Insurance: A New Model for Managing Medical Research Billing, Preventing Insurance Fraud, and Negotiating Budgets with Tr","description":"\u003cp\u003e\u003cb\u003eCoverage is not payment. This single misunderstanding has distorted clinical trial financing for nearly a generation. \u003c\/b\u003e\u003c\/p\u003e\u003cp\u003eFor more than two decades, research institutions have relied on Coverage Analyses to distinguish health insurance-billable routine costs from sponsor-obligated research expenses. This book argues that the Coverage Analysis, while essential for complying with anti-fraud laws, has been misapplied as a budgeting tool in recent years, and that the resulting coverage-centric model of clinical trial financing is no longer tenable for research hospitals under current insurance reimbursement methodologies. The Coverage Analysis remains a critical compliance tool for managing research patient charges but changes in health insurance reimbursement have made the tool outdated as a basis for financing. \u003cbr\u003e\u003cbr\u003eDrawing on the Medicare Outpatient Prospective Payment System (OPPS) and frameworks established in the U.S. Supreme Court's \u003ci\u003eEscobar\u003c\/i\u003e and \u003ci\u003eSuperValu\u003c\/i\u003e cases, the authors demonstrate widespread misalignment of clinical research financial processes-resulting in losses to research sites and increased legal risk. At the heart of the problem is a widely held but empirically false assumption: that insurance coverage equates to insurance payment. Under OPPS, many services Medicare technically \"covers\" receive minimal or no separate payment, imposing hidden losses on institutions and unanticipated out-of-pocket costs for research patients. \u003cbr\u003e\u003cbr\u003eThe book advances a new payment-centric model anchored by the Research Payment Analysis (RPA)-a methodological innovation that replaces coverage determinations with empirical reimbursement data as the foundation for sponsor budget negotiations. The book argues that the RPA offers a better opportunity than a Coverage Analysis for research sites to recoup their costs through industry sponsor budget negotiations, improve time-to-activation for trials, and be on a stronger compliance footing. \u003cbr\u003e\u003cbr\u003e\u003ci\u003eClinical Research \u0026amp; Health Insurance\u003c\/i\u003e has been written for clinical research administrators, hospital revenue cycle professionals, health care lawyers, and compliance officers as well as anyone else seeking a rigorous framework for understanding the intersection of law and clinical trial financing.\u003c\/p\u003e","brand":"LIGHTNING SOURCE INC","offers":[{"title":"New","offer_id":67600235725090,"sku":"9798994985212-new","price":28.53,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0893\/4755\/5618\/files\/9798994985212.jpg?v=1792900745","url":"https:\/\/www.albakireads.com\/products\/clinical-research-health-insurance-new-model-managing-medical-research-billing-preventing-insurance-9798994985212-new","provider":"AlbakiReads","version":"1.0","type":"link"}