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Improving Physician Reimbursement for Trauma Care
This project provides an in-depth assessment of professional fee reimbursement on trauma care provided by trauma surgeons, neurosurgeons and orthopedic surgeons. A limited review of trauma professional fee reimbursement from other specialties will also be done, enabling the identification of total faculty practice trauma related professional fee reimbursement.
Assess Billing & Registry Data on Admitted Trauma Center Patients
B+A’s financial model for projecting professional fees on trauma care for selected trauma specialties will be used to establish a reasonable benchmark on charges and collections for these trauma specialties. Data downloads from the physician billing system and trauma registry will be requested, and then assessed in comparison to benchmarks in the following areas:
- Charges & RBRVS by Billing Area, Provider, CPT-4
- Reimbursement
- Payer Mix compared to national Trauma Center norms
- Account Balances (include estimate of remaining reimbursement)
- Procedural charges by CPT-4
- Analysis of Evaluation & Management charges by CPT-4
- Critical Care E & M charges by CPT-4
- Number of trauma patients with charges by specialty compared to total trauma registry patients
Evaluate Key Components of the Trauma Physician Billing Process
This evaluation will provide a basis to define strategies for optimizing the financial performance of trauma billing for both the short and long term. These strategies will address the following issues:
- Identification of the Trauma Patient
One of the important factors in effectively billing professional fees for trauma patients is accurate identification of the patient on the front end of the process. The project will review the coordination between the billing process and trauma registry data.
- Fee Schedule & Contracting
Bishop+Associates will provide an objective expert evaluation of the current trauma physician fee schedule and prepare a concise analysis in writing. This analysis will address the professional fee pricing structure in comparison to national norms and recommend a pricing policy for the fee schedule.
- Staff Expertise in Trauma Account Management
Assess the current structure of the trauma physician billing program to ensure that adequate resources are dedicated to the trauma account management program. These resources need to have a functioning knowledge base specializing in trauma account management to ensure the long-term success of the program.
- Trauma Physician Billing Program’s Reporting System
Assess the needs of both the hospital and the physicians to ensure that a reporting and feedback system is providing the needed information. Frequent review of the trauma physicians billing program is vital to ensuring the long-term survival of the program.
- Collections and Appeals Process
A review of the trauma physician’s appeals process on low reimbursement and denied claims from insurance payers will be conducted. Bishop+Associates will develop recommendations for the current processes using practical working examples obtained from other trauma center billing programs.
The product for this engagement will be a concise report on findings and recommendations. |
