Expert offers tried and true strategies for balancing the books

CT site quickly turned red ink black

Collecting timely payments from sponsors is a common issue for clinical trial sites. Assigning payments to the correct budget also can be a problem. Mistakes in these areas can lead to cash-flow difficulties.

The good news is that clinical trial sites can improve their billing, budgets, and collections by establishing a thorough tracking program, one expert suggests.

"The big issue is that you could be losing money if you don't have a handle on what is coming in," says Rachel Garman, LPN, CCRC, research manager, oncology, at Cancer Care Northwest in Spokane, WA.

When Garman began working as the manager of the community clinical trial site, she was handed a budget that said the research activities were $80,000 in the hole.

"I did not see how we could be at that level," Garman says.

After an audit and closer look at the budgeting and accounting, she found $22,000 in lost funds.

Sponsor payments that were intended for specific trials were being deposited in the wrong accounts because no one had caught the mistakes. Fortunately, Garman was able to track down the lost money and have it re-deposited in the research account.

Garman also discovered that a very expensive piece of lab equipment was incorrectly charged to the research account.

"It was an error that made my department look bad," she says. "The clinical side should have paid for it, and returning this charge to the clinical side put us back in the black."

These mistakes were all avoidable on the part of the trial site.

"Sometimes it isn't the sponsor making mistakes," Garman notes. "On our end we missed stuff on invoices and billed items incorrectly."

After turning around the trial site's deficit within one year, Garman next tackled the entire billing and collecting process to make certain there would be no future mistakes of that magnitude. Here's how she did it:

• Design billing tracking tools: "They said we could use whatever we wanted as long as it was free," Garman says. "So we made Excel Spreadsheets, designing them to our tracking needs."

The tracking mechanism notes what money is coming in and what it is for. It also lists subjects' initials, time points for receiving payments, dates when money was received, comments, and how much was budgeted for any particular trial and visit.

"I had someone help me who is an Excel genius and could work the spreadsheets very quickly," Garman says. "But even if I had to do it myself, it would be worth its weight in gold."

Each trial has its own spreadsheet because the payment particulars and requirements vary.

"Some trials have you submit the data electronically in order to get paid; some trials have you send an invoice," she says. "Each path is based on that specific need."

For example, in one trial the site doesn't receive payment until the investigator reviews the data and puts in an electronic signature. As a result, that trial's spreadsheet has a way for Garman to track whether the investigator has followed the requirements.

• Keep track of what is billed and what is paid: "I'm looking at the spreadsheets all the time," Garman says. "I have an amounts received column, and I check it to see if the money that came in is the amount I was supposed to receive."

If the amounts billed and paid match, Garman highlights the row in yellow. This way she can take a look at a sheet and easily see where the unpaid items are located.

When she catches an item that was billed, but not paid, she will check up on it to make certain the payment did not arrive in the accounting office and subsequently get put in the wrong place.

"I spend about eight to 12 hours a month checking on these spreadsheets, and some months it'll take longer," Garman says. "The important thing is that it's done in real time, so as soon as a check is received the accounting staff makes a copy and sends it to me."

• Get accounting personnel on board with changes: "I told the accounting office exactly what I needed to make my department function in an optimal setting," Garman says.

The accounting staff complied and now handles the research checks correctly.

Sometimes when Garman is expecting a specific research check, she'll contact the accounting office and let them know that it was billed that week and is expected to come in shortly.

"The tough part is when the odd check comes into the practice and it comes to me because it doesn't have anything to do with research," Garman says. "I weed it out and send out what's not mine."

• Address late payments: "This hasn't been a huge issue — just a couple of isolated cases," she notes. "But you have to be aggressive."

When a sponsor is late with a payment, Garman first sends out an email that says the subject was seen on this date and the payment has not yet arrived.

"I ask where they stand with this payment." she says.

Then if there still is no payment, Garman will send the sponsor a duplicate invoice by email in order to reiterate the request for payment.

"I send out emails for documentation purposes," she says.

For the rare occasions when the payment still does not arrive, Garman will call the point person about it.

"If we have somebody we're not getting payments from, we'll look at this issue when we do a study feasibility," Garman says.

The key to improving a clinical trial site's billing practice is to have checks and balances in place, she says.

"You need to keep a tight rein on it and verify why you haven't been paid," Garman says. "You can't have outstanding funds, and the longer they haven't been received, the harder they are to get."