The World of Coding and Medical Billing Fraud – Part 4: Trauma Team Activation

by Andrea Vieten
Close up photo of red large letters spelling emergency
Header Photo: Getty Images

One of the most expensive charges on a hospital bill in case of a motor vehicle accident is the trauma team activation. Depending on the state, costs for a single trauma team activation vary between $8,000 and $30,000.

A trauma team is a multidisciplinary group of individuals drawn from the specialties of emergency medicine, intensive care, surgery, nursing, allied health and support staff, who work together as a team to assess and manage a trauma patient admitted to hospital. In case of an accident, the emergency providers have to determine at the accident location, whether or not to initiate a trauma team as care by specialized trauma teams at designated trauma centers has been shown to improve survival.

There are stringent rules when to initiate a trauma team. Within the US, there is a tendency for some hospitals to bill a trauma activation fee for all patients whose injuries arise from a motor vehicle accident, no matter how minor the accident or injuries are. This billing behavior results in unnecessary high trauma team activation charges, placing a high financial burden on health insurers.

As part of the Fraud Fact Friday series, our medical billing experts, Tami Rockholt and Mike Fossey, describe the problem of invalid trauma team activation and explain what health insurers can do to prevent unnecessary charges.

RiskShield automatically detects inappropriate trauma team charges based on the severity of the injuries treated in the hospital on the day of loss.

This way, RiskShield can identify and alert unnecessary charges with health insurance companies to save thousands or even tens of thousands of dollars.

Read more about inappropriate trauma activation charges.

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About the author

  • Andrea Vieten

    As a Senior Business Consultant at INFORM GmbH, Andrea Vieten has been responsible for managing global implementation projects in the financial industry. With more than 10 years of experience, she has consulted and guided many financial institutions to the successful implementation of intelligent decision systems in the areas of risk, processes and compliance.

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