OHSU

Medicare Advantage

Medicare Advantage research subjects on a qualifying non-device study must have the Clinical Trial Medicare guarantor linked to their registration in Epic in order for billing to be done properly. See Identifying Medicare Advantage Research Patients for more information.

 

When a patient consents on a clinical trial

Enter the subject into eCRIS within 3 days.

 

The CRBO will determine if the patient is covered by a Medicare Advantage Plan and if the study is considered a qualifying clinical trial.If so, the CRBO will request that Registration assign the Clinical Trials Medicare guarantor to the patient's insurance coverage.  You will be notified of the determination and the assignment of the Clinical Trials Medicare guarantor.

 

For the Patient

Please provide the patient with a copy of the Medicare Advantage Plans & Clinical Trials patient handout. 

 

Out of Network Patients

If a patient is coming to OHSU to participate in a trial and will be out of network for their Advantage Plan in doing so, he/she will need to sign a Notice of Non-Covered Charges form at the time of the first visit.  This is necessary because if the patient is seen by the physician and he/she does not go forward with consent and screening, the charge for that visit will NOT be billed to Medicare and will be the responsibility of the patient.

 

Insurance Changes

If a patient's insurance changes during the course of the study and he/she is now active on, or no longer on, a Medicare Advantage plan, please email CRBO@ohsu.edu with the date of the coverage change.  If you were not aware that the study patient was on a Medicare Advantage plan and become aware after study services have been performed, please notify CRBO@ohsu.edu immediately.  We will coordinate any refunding or rebilling that needs to be done.

 

When patient is no longer receiving clinical services on study

Subject visits will be completed within eCRIS within 3 days of completion and when the final study visit for the subject transitions their status to Off study, the active Research indicator in Epic will be made inactive. 

The Clinical Trial Medicare guarantor will be terminated at that point so that charges from that date forward go to the patient's managed care plan.

 

Return to main CRBO page.