Maximizing reimbursement from trauma response fees (UB-92: 68X) - lessons learned from a hospital comparison.
BACKGROUND
The trauma response fee (UB-92:68x) recently has been approved, to be used by hospitals to cover expenses resulting from continuous trauma team availability. These charges may be made by designated trauma centers for all defined trauma patients when notification has been received before arrival (eligible pt). This study compares two trauma centers' performance in collecting this fee help define methodologies that can enhance reimbursement.


METHODS
Our trauma system uses two hospitals (A and B) that are designated as the Level I trauma center for the region on alternate years. This allows hospital performance comparisons with relatively consistent patient demographics, injury severity, and payer mix. Data were collected for a one-year period beginning on January 1, 2003 and included charges, collections, and payer source for the trauma response fee. This time frame allowed the comparison of two six-month sequential periods at each trauma center.


RESULTS
Out of a total of 871 trauma patients, 625 were eligible for the trauma response fee (72%): hospital A = 65% and hospital B = 77%. Total trauma response fee charges for both centers were 1,111,882 dollars with collections of 319,684 dollars (28.8%). The following payer sources contributed to the collections: Indemnity insurance (77.4%), Managed Care (22.1%), Medicare (0.3%), and Medicaid (0.2%). No collections were obtained from any self-pay patient. Eligible patients were charged a trauma response fee much less frequently in Hospital A than B (29.35% versus 95.2%) but revenue / charge ratios were equivalent at both hospitals (0.32 versus 0.28). These differences resulted in markedly enhanced revenue for each eligible patient in Hospital B compared with A (735 dollars versus 174 dollars)


CONCLUSIONS
Enhanced collection by hospital B was a result of a higher charge, compulsive billing of all eligible patients, and emphasis on pre-admission designation of trauma patients. Effective billing and collection process related to trauma response fees results in substantial additional revenue for the trauma center without additional expense.
Fortune
John B
JB
Southern Illinois Trauma Center, Springfield, Illinois, USA. fortunej@upstate.edu
Wohltmann
Christopher
C
Margold
Brenda
B
Callahan
Charles D
CD
Sutyak
John
J
D000046:Academic Medical Centers / Q000191:economics; D000573:American Hospital Association; D004608:Eligibility Determination; D005377:Financial Management, Hospital / Q000191:economics / Q000379:methods; D006302:Health Services Research; D049228:Healthcare Common Procedure Coding System / Q000191:economics*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D016519:Hospitals, Religious / Q000191:economics; D006801:Humans; D007087:Illinois; D007182:Income / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008329:Managed Care Programs / Q000191:economics; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D010350:Patient Credit and Collection / Q000191:economics / Q000379:methods; D018579:Patient Selection; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States