| Assists surgeons with improvement to reimbursement for the hard work of trauma care
Consolidated trauma billing programs strengthen medical staff commitment to trauma care by optimizing professional fee revenue. This project will analyze current operations, assess current resources, and prepare a concise, comprehensive plan that will enable a clear understanding of the proposed billing program as well as its timely and effective implementation.
Trauma billing programs should meet the unique needs of trauma physicians while making the best use of the hospital resources. This task will identify available billing resources that can be utilized and determine components of the billing process which need to be contracted out. The following will be reviewed:
- Any current physician billing resources
- Trauma coding expertise
- Unique regional MCO/appeals challenges
- Other regional issues or resources
An understanding of the scope and likely revenue of the trauma billing program as well as its operating costs will be essential for its development and success. This task, using our physician billing data base and modeling capability, as well as hospital trauma volume, severity and payer mix data, will project the following:
- Charges & collections
- Operational costs of billing program
- Hospital costs for any professional fee subsidies provided
A trauma billing program requires a unique provider number to enable trauma physicians to bill as an independent entity. This new provider number facilitates billing at a higher conversion rate and enables physicians to circumvent existing managed care contracts for trauma care. This structure will define:
- Corporate structure in collaboration with hospital attorney
- Tax identification number & provider number arrangement
- Governance structure for policy development and performance review
- Relationships with hospital, physicians and technical stockholder (if needed)
- Necessary contracts with physicians (if needed)
(We will define contract parameters and provide samples to attorney)
- Staffing and reporting structure
Compliance issues regarding confidentiality of patient information and physician billing will be reviewed.
This project will also outline the numerous billing program and process components to guide their implementation. This will include:
- Trauma physician fee schedule
- Charge documents
- Professional fee coding
- Billing system
- Software and hardware
- Follow-up system
- Appeals system
- Payment posting system
- Banking arrangements
- Reporting system
- Program management
We will identify key implementation components, steps, and processes along with their timeframe and responsibility. They will include:
- Corporate structure development
- Obtaining tax Identification and provider numbers
- Contract development
- Necessary physician credentialing
- Staff and reporting structure
- Training for physicians, billing staff and trauma program management
- Balance of billing program components
It is important that the responsibilities of both the hospital and participating physicians be clear from inception, and this task will insure this by defining:
- Hospital responsibilities
- Physician responsibilities, including:
- Trauma program participation responsibilities
- Documentation and claim submittal
- Participation in program guidance and support (e.g., review system for problem accounts or participants)
The product for all components of this engagement will be a concise outline of findings and recommendations.
Training of both physicians and support staff is one of the most important elements of a successful consolidated trauma physician billing program. Training will include documentation and coding requirements, collection strategies with 3 rd party payers and patients, and billing process management. Participants will include:
- Trauma Physicians
- Hospital Registration Staff
- Professional Billing Staff
- Trauma Program Staff
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