The devil is in the details: maximizing revenue for daily trauma care.
BACKGROUND
Falling reimbursement rates for trauma care demand a concerted effort of charge capture for the fiscal survival of trauma surgeons. We compared current procedure terminology code distribution and billing patterns for Subsequent Hospital Care (SHC) before and after the institution of standardized documentation.


METHODS
Standardized SHC progress notes were created. The note was formulated with an emphasis on efficiency and accuracy. Documentation was completed by residents in conjunction with attendings following standard guidelines of linkage. Year-to-year patient volume, length of stay (LOS), injury severity, bills submitted, coding of service, work relative value units (wRVUs), revenue stream, and collection rate were compared with and without standardized documentation.


RESULTS
A 394% average revenue increase was observed with the standardization of SHC documentation. Submitted charges more than doubled in the first year despite a 14% reduction in admissions and no change in length of stay. Significant increases in level II and level III billing and billing volume (P < .05) were sustainable year to year and resulted in an average per patient admission SHC income increase from $91.85 to $362.31.


CONCLUSIONS
Use of a standardized daily progress note dramatically increases the accuracy of coding and associated billing of subsequent hospital care for trauma services.
Barnes
Stephen L
SL
Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA. barnesste@missouri.edu
Robinson
Bryce R H
BR
Richards
J Taliesin
JT
Zimmerman
Cindy E
CE
Pritts
Tim A
TA
Tsuei
Betty J
BJ
Butler
Karyn L
KL
Muskat
Peter C
PC
Davis
Kenneth
K
Johannigman
Jay A
JA
D003362:Cost-Benefit Analysis; D004282:Documentation / Q000191:economics / Q000592:standards; D005251:Fees, Medical; D005260:Female; D005377:Financial Management, Hospital / Q000191:economics; D019538:Health Care Surveys; D049228:Healthcare Common Procedure Coding System / Q000191:economics*; D017722:Hospital Charges / Q000592:standards* / Q000639:trends; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000639:trends; D008297:Male; D008505:Medical Staff, Hospital / Q000191:economics; D010350:Patient Credit and Collection; D011336:Probability; D012680:Sensitivity and Specificity; D014193:Trauma Centers / Q000191:economics* / Q000706:statistics & numerical data; D014194:Traumatology / Q000191:economics; D014481:United States