A prominent Level I Trauma Center in the northeast was looking to improve their billing procedure processes to become more efficient and increase revenue. The hospital partnered with Philips to perform a financial performance evaluation and develop a strategic approach for optimal trauma center billing management. It is well established that the expense of maintaining a trauma center is substantial. If not properly managed, trauma services can become a financial drain on the institution. The hospital had recently undergone two performance improvement initiatives which resulted in improved time to reversal agents from four hours to ninety minutes and a reduced non-surgical admission rate from 28% to 5%, exceeding the national standard of 10%. However, these efficiencies were not translated into expected financial gain.
Analysis of the data provided by the hospital included all patients who received a “Full” or “Modified” trauma team activation. A discrepancy identified a difference of 210 records without FL 14, Type 5 designation who met criteria for inclusion. Omission of FL 14, Type 5 for these patients indicated the inability to submit a bill for the activation fee (UB 681). Review of the UB 681 identified another discrepancy in coding critical care time of more than $460,000 in lost charges. In addition, UB 208 had not been implemented which would add more than $650,000 in additional annual charge capture.
FL 14, Type 5 is used by patient access in the registration process to identify the type of patient priority. Type 5 = trauma UB 681 is for reporting trauma team activation costs and is used in conjunction with UB 450 for emergency department services UB 208 is the inpatient revenue code for daily intensive care room charges for trauma patients only
Based on the assessment, Philips Trauma Center consultants recommended four different operational adjustments to maximize revenue potential.
Philips consultants recommended creating a finance committee to implement suggested changes, which could result in an estimated increase in annual gross charges of more than $1.5 million. But more importantly they could reduce over and under triage rates to industry norms.
*Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.
Angie Chisolm, MBA/HCM, BSN, RN, CFRN, TCRN Consulting Manager
Angie is a nationally recognized expert in trauma program and emergency services management. She is a results-driven leader with expertise in trauma program operations, providing mentoring and consulting focused on coding and billing, site survey readiness, performance improvement, and operational efficiency.
You are about to visit a Philips global content page
Continue Theresa Radeker, MHA, BSN, RN, TCRN Consultant
Theresa is a high-energy and results-driven hospital operations executive, with a proven track record of achievement in trauma program management, project management, service line leadership, hospital administration, physician recruiting, and quality and compliance.
You are about to visit a Philips global content page
ContinueYou are about to visit a Philips global content page
Continue