Staying Up to Date with the CMS Data Report Card (Live)-Handout: Staying Up-to-Date

Handout: Staying Up-to-Date

Pdf Summary

The document presents an educational activity hosted by the Trauma Center Association of America (TCAA) for understanding and improving the billing and reporting of trauma-related services on Medicare claims. Valerie A. Rinkle from Valorize Consulting LLC highlights key aspects regarding the standardized processes of coding and reporting trauma cases to optimize accuracy and efficiency. <br /><br />Medicare annually releases complete inpatient and outpatient claims data, excluding Medicare Advantage, and this data is critical for trauma centers to benchmark against national data and uncover areas for improvement. The data set for 2023 emphasizes adhering to the National Trauma Data Bank Standards, using precise ICD-10-CM diagnosis codes, and revenue codes to form trauma center reports.<br /><br />Insights include that only a small percentage of inpatient trauma claims fully utilized the appropriate billing codes, indicating potential underreporting or misbilling by many centers. The document stresses the importance of using correct codes for trauma response (Form Locator 14) and trauma charges (revenue codes 068x and 045x). Accurate reporting affects both reimbursement and internal assessments of care and resource usage.<br /><br />For outpatient cases, the report highlights frequent omissions of critical care billing codes, which can result in lost Medicare payments. Most notably, the HCPCS code G0390 for trauma responses with pre-arrival notifications is underreported.<br /><br />Trauma centers are encouraged to ensure accurate documentation and coding practices, and collaborate across departments to improve the integrity of claim submissions. The TCAA data is intended as a benchmark for performance and encourages feedback to refine future reports. Additional resources and access to reports are provided for further insights into improving reports of trauma services in medical claims.

Keywords

Trauma Center Association of America

Medicare claims

trauma-related services

billing and reporting

ICD-10-CM codes

National Trauma Data Bank Standards

trauma center reports

Form Locator 14

HCPCS code G0390

claim submissions