Our expert medical bill reviewer and clinical analyst recently identified a case where the application of a trauma activation fee was seriously questionable.
Hospital trauma fees are under scrutiny across the country in general. Hospitals charge patients a trauma activation fee when they arrive by ambulance with a serious injury. These fees, ranging in the thousands of dollars, are unregulated. Some hospitals will not publicly reveal how they charge in these cases.
States like Connecticut are looking to change this. New legislation will require Connecticut hospitals to disclose to the state Office of Health Strategy next year the amounts they assess for trauma activation fees.[i]
Only designated trauma centers can use the billing code 068x to charge a trauma activation fee.
What our expert gleaned from the medical record during a recent bill review was that the pre-hospital notification time was 6:30 pm and the arrival time was 7:46 pm. 1 hour 46 minutes later! Normally trauma hospitals only have 30 minutes to respond to a trauma. That is one of the reasons why it is so hard to authenticate trauma activation status.
The medical record the specialty of each care provider in this case was noted. ALL of those staff members are already in the hospital except perhaps a trauma physician and a CT tech. If they are on call, they have only 30 minutes to get to the hospital.
The bottom of the form is the assessment of the patient. Details show the patient was clearly alert, breathing on his own with equal breath sounds, had a pink complexion, and was talking on arrival. This is not indicative of a trauma. He did have a fractured clavicle that required pain medication. It’s possible that there were other complications, but these are not noted in the medical record.
In this case, our expert eliminated an inappropriate $25,000 level 2 trauma fee that would ultimately have been passed on to the patient.