Avoid trauma payment trouble by appropriately managing patient upgrades and downgrades

Authored by:
Angie Chisolm, MBA/HCM, BSN, RN, CFRN, TCRN
President and Managing Partner

As published by Trauma System News

The U.S. Office of Inspector General (OIG) recently launched a review of Medicare payments for trauma claims.

One focus of the OIG review is trauma team activation (TTA) payments to hospitals that are not properly designated or verified trauma centers. While this is a genuine concern for the government, it is fairly easy for hospitals to avoid getting into trouble on this point.

(In case clarification is needed, if your hospital is not properly designated by your state or verified by the American College of Surgeons as a trauma center, you cannot bill for TTAs.)

In contrast, the major focus of the OIG review is actually a complex challenge for trauma centers: improper billing for TTAs that are not medically necessary.

Based on discussions I have had with centers that have been interviewed by the OIG, the key issue is patient upgrades and downgrades after activation. Hospitals that do not handle upgrades and downgrades correctly may end up billing for TTAs that were not medically necessary, exposing their organization to payer scrutiny.

In this article, I go over the basic concepts of upgrades and downgrades, explain the risks and benefits, and outline strategies for making sure your center is appropriately billing for TTAs when there is a change in the level of response.

Read the full article:  avoid trauma payment trouble by appropriately managing patient upgrades and downgrades