Rural New England Hospital

A CA-based Health System including two acute-care medical centers, a behavioral health center and multiple urgent care, outpatient care, clinical laboratory and imaging centers. 733 licensed beds. Main campus serves as designated Level II Trauma Center for two-county region of 1.5 million plus people.


Increased critical care professional fees by approximately $125,000 per year

Developed feedback loop between the hospital billing office and the physicians to ensure that physician documentation supports the level of billing their work justifies.

Identified opportunities to optimize professional fees to reduce hospital subsidies for critical care coverage.

Removed barriers to change in current billing practice.

Identified future opportunities to increase the volume of critical care patients and ensure the capture of ventilator charges.


Critical Care time-based professional fees were rarely used by physicians in the ICU. An evaluation of the ICU Care at this hospital revealed that the physicians were not billing for critical care time. Over one-third of the critical care patient days could be billed with critical care professional fees each day. The current proportion was 2%.


Conducted site visits and interviews with hospital leadership, hospital staff and medical staff, chart reviews and financial analysis


The ICU was serving as a medical/surgical overflow unit for 50% of the patients in the ICU.

The physicians did not always appropriately document their time spent on providing critical care or randomly billing codes were randomly applied.

The critical care time-based professional fees were not being billed because the billing office staff was not “comfortable” using these codes.

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HealthWorks is one of only three valuation and litigation firms in the U.S that specializes in trauma centers and trauma center planning and operations improvement. It is the only one of the three firms that also specializes in FMV. Included among HealthWorks 2,400 FMV opinions are more than 350 in the core specialties in trauma centers.