Customer story

Improving trauma center financial performance through operational efficiency

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Trauma center consulting helps implement effective coding, billing and collection practices

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. 

Assessment

 

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.

Trauma specific coding

 

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 

Assessment recommendations

 

Based on the assessment, Philips Trauma Center consultants recommended four different operational adjustments to maximize revenue potential. 

 

  • Consistency in FL 14, Type 5 assignment to correctly identify trauma patients in the Emergency Department. 
  • Implementation of a multi-tier trauma team activation protocol, so patients receive the right care at the right time by the right providers, decreasing valuable resource utilization and costs. 
  • Documentation of critical care time associated with trauma team activation includes entire team time and is not limited to physician critical care time
  • A trauma patient in any critical care setting should receive the daily revenue code UB 208. 

Results*

 

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.

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*Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.

Meet our team

Beth Fuller

Angie Chisolm, MBA, 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. 
Theresa Radeker

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.

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