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Related Experiment Videos

Reducing trauma payment denials with computerized collaborative billing.

R Lawrence Reed1, Kimberly A Davis, Geoffrey M Silver

  • 1Department of Surgery, Layola University Medical Center, Maywood, Illinois 60153, USA. rreed@lumc.edu

The Journal of Trauma
|October 21, 2003
PubMed
Summary
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A new networked billing program significantly reduced payment denials for trauma surgeons by crosschecking global surgical package coding. This collaborative approach improved billing efficiency and financial recovery for professional trauma care services.

Area of Science:

  • Trauma Surgery
  • Healthcare Administration
  • Medical Billing

Background:

  • Trauma care relies on physician availability through rotational coverage.
  • Third-party payers often view trauma surgeon bills as from a single entity, regardless of multiple providers.
  • Surgeons may lack awareness of colleagues' billing for jointly managed patients, leading to potential coding issues.

Purpose of the Study:

  • To investigate the impact of a networked billing program on reducing payment denials.
  • To assess the program's effectiveness in addressing global surgical package coding concerns.
  • To determine if a collaborative billing system improves financial outcomes in trauma care.

Main Methods:

  • Implementation of a networked relational database for trauma surgeons to log billable encounters.

Related Experiment Videos

  • The system displayed global periods and diagnoses, prompting for necessary postoperative modifiers.
  • Comparison of payment denial rates for evaluation and management services and postoperative procedures before and after program implementation.

    • Main Results:

    • Payment denials for bundled evaluation and management services decreased from 361 to 16.
    • Denials for bundled postoperative procedures dropped from 55 to 13.
    • Overall savings reached $183,404, with reduced billing time and improved legibility.

    Conclusions:

    • Collaborative billing systems can effectively mitigate payment denials in trauma care.
    • Networked billing programs enhance accuracy and efficiency in managing professional trauma care payments.
    • Implementing such systems leads to significant financial improvements and operational benefits.