Trauma Billing: More Complex Than You Think!
*Lee Ann Wurster, *Rajan Thakkar, Deborah Faehnle
Nationwide Children's Hospital, Columbus, OH
Background: Trauma billing is complex and many trauma programs rely on hospital billing specialists to ensure accurate coding. The purpose of this project was to conduct a trauma-specific coding and billing assessment to identify areas for operational improvements at a busy Level 1 Pediatric Trauma Center.
Significance: Evidence has shown improved patient outcomes for severely injured pediatric patients treated at verified trauma centers. The “cost” of an organized trauma team response is significant. Optimal trauma billing can help trauma centers recover some of the uncompensated costs that are incurred in the delivery of trauma care.
Methods: Trauma Leadership worked with hospital finance team members to ensure utilization of the correct fields to meet CMS trauma billing requirements. Once established, a monthly trauma activation billing report was generated to track compliance. Operational changes included physician education to ensure minimum documentation standards were met, patient arrival and prenotification documentation validation, and new claim logic was built into the EMR to minimize missed charges being sent out. Results: A review of the data identified several omissions including a lack of the FL-14 type 5 field, underutilization of revenue code 068x, inconsistent use of CC 99291 with G0390, and failure to use revenue code 0450 for emergency care with 0681 for trauma activations. A six-month audit of pre-implementation charge detail identified a potential revenue loss of > $1,600,000. Conservative estimates, which included only cases with prenotification and ≥ 31 minutes of critical care time, showed post-implementation revenue potential of > $800,000.
Conclusions: Full capture of trauma activation charges can be optimized when trauma program leaders and hospital finance departments work together to minimize revenue losses. Regardless of current reimbursement status, accurate billing is critical to maximize future contract payment agreements.
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