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Clinical Trial Accounting Accrual: Why It Matters and How to Do It Without Losing Your Mind

  • Writer: Kelly Breuer
    Kelly Breuer
  • Jul 7
  • 2 min read

Startups live in the world of cash flow, investor updates, and small teams. When it comes to clinical trials, every dollar 'counts' (haha)- and so does showing that you know where those dollars are going AND where they're going to go. That’s where clinical trial accounting accrual comes in.


Why Accruals Are Critical in a Startup Environment

  1. Cash Is Tight and Time Is Short You need to know what your trial costs right now, not 60 days from now when a site finally submits an invoice. You need a process for tracking what’s been done, what’s been paid, and what’s still hanging out there.

  2. Investors Are Watching It sounds ominous, but it's very true. Transparent, timely accruals help your CFO or finance lead report realistic burn rates and project future spend. This builds investor confidence.

  3. Audit Prep Starts Early Even pre-revenue companies are expected to show sound financial controls, especially in due diligence or FDA-facing studies.


Steps to Build a Practical Accrual Process

  1. Track Site Activity in Real Time I use a variety of systems and spreadsheets to know when subject visits, monitoring visits, and major milestones happen.

  2. Estimate Based on Your Contracts Pull the cost information directly from the FE CTAs and vendor agreements. If a Baseline Visit at Site 1 is $800 and you had 4 visits last month, accrue $3,200- whether or not the invoice has arrived.

  3. Don’t Forget Vendors Does your study use lab kits or a Core Lab? Were new EDC licenses activated? All of these should be accrued for.

  4. Document Everything Keep a simple audit trail. A spreadsheet showing visit counts x unit cost is enough. When real invoices arrive, true up the difference.

  5. Build the Muscle Early It doesn’t have to be perfect. Start with a basic accrual template and improve over time. The key is consistency and visibility.


Bottom Line (again, haha)

Clinical trial accruals definitely feel like a finance headache, but I grudgingly admit they’re an important tool. They keep you aligned with reality, ready for board questions, audit-ready, and in control of your clinical spend.


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