Coverage Analysis for Clinical Trials

Trusted by 125+ sites to complete over 3,600 coverage analyses in 2023.

For many research sites, coverage analysis is among the most time-consuming aspects of study start-up, with over 70% of sites reporting it as the top cause of their study start-up delays*. If your site is looking to reduce your coverage analysis turnaround times and improve your start-up timelines, look no further than WCG.

By partnering with WCG, your research site gains an experienced “right-sized” coverage analysis and billing compliance team that ebbs and flows with your study volumes. Our support can be project-based or ongoing, helping your site increase efficiency, quality, and compliance.

*WCG’s 2024 Site Challenges Report

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Setting the standard for coverage analysis – what our experts provide

Our team of coverage analysis experts carefully review clinical trial procedures and services to distinguish between billable and non-billable items, verify Medicare coverage eligibility, and detect potential duplicate billing. By thoroughly analyzing National and Local Coverage Determinations, Medicare-approved guidelines, and site-specific policies, we deliver comprehensive coverage analyses that help sites accurately manage their research billing and reduce the risk of improper billing.

By partnering with WCG for coverage analysis, we can help your site

Improve turnaround times and streamline study start-up

Ensure you always get the fast and reliable turnaround times you need to start your trials sooner with an expert partner whose support can be adjusted to fit your site’s changing study volumes.

Reduce administrative burden and alleviate resource limitations

Reduce the administrative burden of coverage analysis and free up valuable time for your staff – allowing them to focus on higher-value tasks.

Ensure proper billing compliance and mitigate risks

Protect your site’s reputation and financial well-being by establishing proper billing and regulatory compliance, optimizing reimbursement, and mitigating risks.

The gold standard in coverage analysis – WCG’s proven results and experience:

5-day

turnaround for our coverage analysis services

3.6k+

coverage analyses performed on behalf of sites in 2023

2.2k+

unique trials supported by WCG’s study start-up services in 2023

125+

sites utilizing WCG’s coverage analysis services

Coverage analysis FAQs

Coverage analysis is the output of a review to determine which procedures are potentially billable to trial participants’ insurance and which should be included in the clinical trial budget. The coverage analysis may be a separate document or incorporated into a CTMS. A strong coverage analysis will include billing determinations for each procedure, along with consistent justification documenting each decision.

Coverage analysis is the foundation for a compliant research billing process. Institutions that improperly bill Medicare for protocol tests and procedures are at risk of fines up to $20 million.

The best practice recommendation is for a site to complete their coverage analysis prior to reviewing and negotiating a budget with the sponsor. To maintain compliant billing practices, it is critical that the coverage analysis aligns with the budget and contract. By completing the coverage analysis prior to negotiating a budget, sites can ensure that the final budget appropriately captures the coverage analysis findings.

The best practice recommendation is for a site to complete a coverage analysis for any trial that includes tests or procedures that may be potentially billable to the participants’ insurance.