How to Build a Successful and Sustainable Coverage Analysis Team

Ryan Monte
Senior Product Marketing Manager, Forte
February 21st, 2019

For those in the clinical research industry, conducting a Medicare Coverage Analysis (MCA) is one of the most challenging aspects of a clinical trial. Understanding reimbursement guidelines and practically applying them to your studies is often confusing, and the penalties for non-compliant billing can be severe. As a result, it’s important to build a coverage analysis team that’s compliant, consistent and sustainable.

Forte recently conducted an educational webinar featuring industry leaders who discussed their best processes for financial management in clinical research. Bishoy Anastasi of UCLA and David Goodrich of Indiana University shared their institutions’ methods for addressing problem areas in financial operations, including the creation of a successful coverage analysis program. Below are some key areas they highlighted.

Finding (or Creating) Qualified Analysts

As anyone who has built a coverage analysis team can tell you, hiring qualified coverage analysts can be a daunting task. The idea of a team of analysts dedicated solely to ensuring compliant billing is a relatively new phenomenon, and many organizations have struggled to establish a successful program.

Those who have built a strong team typically understand the immense value of their analysts, and work hard to ensure they remain with the organization. As a result, clinical research leaders have had to find new ways to address organizational need, including developing talent from within. When developing new talent, there are a few foundational skill sets that you should seek out when seeking potential internal candidates. These include:

  • Familiarity working with clinical research protocols
  • Previous experience working in clinical research finance
  • An understanding of the ins and outs of building and negotiating a clinical trial budget

Building a Training Program

Creating a successful program to train your analysts is just as important as finding the right talent. This program should go beyond typical methods such as training manuals. UCLA built a comprehensive training program that includes a practicum with actual protocols built into a training environment. The program allows analysts to go beyond simply identifying a coverage decision, giving them the opportunity to train in an environment that closely mimics the one they will work in upon completing their training. This includes identifying qualifying clinical trials, applying billing designations and citing the appropriate guidelines to support their decisions.

For OnCore Enterprise Research users looking to boost their coverage analysis training, Forte worked with Research Matrix to create the Coverage Analysis Certification™ Workshop. The program provides comprehensive training to streamline coverage analysis and study activation processes. Attendees learn advanced coverage analysis principles while earning up to 16 hours of Continuing Education Credit through SOCRA and ACRP.