What is different about the coverage of clinical study services for Medicare Advantage Plan beneficiaries?There are special rules for individuals enrolled in a Medicare Advantage Organization (“MAO”) who may also participate in a qualifying trial. These rules are even more complex than those for individuals who participate in Medicare fee-for-service.
Be sure you understand the specific coverage allowance and billing requirements of a subject’s insurer before billing any clinical trial services to a Medicare Advantage Plan.
For additional information about clinical trial billing to MAOs, please see:
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R107MCM.pdf (Section 10.8- Clinical Trials)