Clinical trial financial accruals are often treated as a finance-only concern—something handled quietly at month-end by accounting teams after the “real work” of running the trial is done. In reality, accruals sit directly at the intersection of clinical operations, finance, and compliance. When accruals are inaccurate, it is rarely because finance misunderstood accounting rules; it is because clinical reality was not captured, translated, or trusted.
For clinical professionals—study managers, CTMS owners, clinical operations leaders—understanding accruals is no longer optional. Accrual accuracy increasingly shapes portfolio decisions, CRO governance, site relationships, and executive confidence. This article explains what clinical trial accruals really are, why they so often fail, and how modern CTMS- and CTFM-driven models are changing the game.
At its core, a clinical trial accrual answers a simple question:
“What clinical work has already happened, and therefore should already be recognized as expense?”
Accruals are not forecasts, invoices, or budget placeholders. They are an accounting representation of services rendered but not yet paid. In clinical trials, those services include:
Accounting standards require that these costs be recognized when the work occurs, not when an invoice is received. That principle sounds straightforward—but clinical trials make it extremely hard to implement in practice.
Accrual failures are not caused by bad intent or lack of effort. They stem from structural disconnects between how trials operate and how financials are managed.
Clinical work happens at sites, in monitoring visits, and inside operational systems. Finance systems, however, need clear, validated events that can be translated into monetary units. When visit completion, verification, or milestone achievement is ambiguous, finance has no stable foundation for accruals.
Many organizations still rely heavily on invoices to “true up” accruals. But invoices often lag reality by weeks or months and may reflect negotiated payment structures rather than actual clinical progress. This creates large month-end adjustments and erodes confidence in reported numbers.
In the absence of a system-driven model, accrual logic is frequently embedded in spreadsheets owned by individuals. These spreadsheets attempt to reconcile CTMS data, CRO reports, and finance assumptions—but they are opaque, fragile, and nearly impossible to audit.
Clinical teams assume finance “handles accruals.” Finance assumes clinical teams will explain variances. The result is shared accountability without shared tools or definitions.
Accrual accuracy is no longer just an accounting hygiene issue. It directly affects how trials are perceived, funded, and governed.
In short, accruals are a reflection of how well an organization understands its own trials.
Modern clinical organizations are moving away from invoice-driven accruals toward event-driven accruals, with CTMS as the system of record.
In an event-driven model:
This shift fundamentally changes the role of CTMS. CTMS is no longer just a planning and tracking tool—it becomes the financial truth source for clinical activity.
High-performing organizations share several characteristics when it comes to accruals:
A subject visit only accrues once it is complete and verified, not when it is scheduled or assumed. This protects both finance accuracy and audit defensibility.
Rate cards, milestone definitions, and accrual rules are configured centrally, not recreated in spreadsheets. Everyone knows what triggers cost recognition.
Teams track how much of expected spend is backed by verified events versus assumptions. Gaps are visible and explainable.
When accruals change, teams can quickly attribute the movement to volume, rate, mix, timing, or FX—not guesswork.
A CTMS-centric accrual model depends on a few critical capabilities:
When CTMS captures events with this level of discipline, accruals stop being estimates and start being evidence-based.
One of the most powerful effects of event-driven accruals is the collapse of the artificial boundary between operations reporting and financial reporting.
Instead of waiting for month-end closes:
This alignment enables faster decisions—whether reallocating budget across studies, addressing underperforming regions, or preparing leadership updates with confidence.
It is tempting to view accrual improvement as a tooling upgrade. In reality, it represents a cultural shift.
Clinical professionals must recognize that:
When clinical teams understand how their actions directly influence financial truth, accruals stop being a monthly fire drill and become a shared operational discipline.
Clinical trial financial accruals are no longer a back-office accounting exercise. They are a reflection of how well clinical reality is captured, governed, and translated into financial truth.
For every clinical professional, the takeaway is clear:
If you want predictable budgets, credible forecasts, and confident leadership conversations, you must care about accruals.
When accruals are driven by CTMS events rather than invoices and spreadsheets, organizations gain more than cleaner books—they gain control, trust, and the ability to run trials with financial and operational clarity at the same time.