Current through Vol. 42, No. 1, September 16, 2024
(a) Each trauma
facility shall detail eligible trauma cases, cross-reference report components,
detail and summarize uncompensated care, and report the facility's cost to
charge ratio on a "Hospital Claim Form" that includes the following:
(1) Demographic data downloaded from the
trauma registry including:
(A) Creation
number of the Trauma registry entry;
(B) Patient's Social Security Number, if
available;
(C) Medical record
number for the trauma facility;
(D)
Patient's date of arrival at the trauma facility in the format
mm/dd/yyyy;
(E) Patient last
name;
(F) Patient first name;
and
(G) Patient date of birth in
the format mm/dd/yyyy, if available
(2) Financial Information from the trauma
registry and/or the financial records of the trauma facility and
cross-references and calculations including:
(A) Total hospital charges as reported in the
trauma registry;
(B) Total
collections as reported in the trauma registry;
(C) Total hospital gross revenues as reported
in the trauma facility's financial records;
(D) The cost to charge ratio for all
departments of the facility in place as of the patient's date of arrival at the
trauma facility;
(E) Adjusted
hospital gross revenues calculated by multiplying the figure in C of this
paragraph by the ratio in D of this paragraph;
(F) Actual total collection for the patient's
services as of the date the "Hospital Claim Form" is prepared by the trauma
facility;
(G) Contractual
adjustments pertinent to the trauma services received by the patient;
(H) The trauma facility's uncompensated care
services for the patient calculated by subtracting the figures in items F of
this paragraph and G of this paragraph from the calculated amount in E of this
paragraph.
(b) Each free-standing ambulance service
shall detail eligible trauma cases, detail and summarize uncompensated care on
an "EMS Claim Form" that includes the following:
(1) Demographic data extracted from the run
report including:
(A) Run report number or
lithocode;
(B) Transported person's
Social Security Number, if available;
(C) Transported person's last name;
(D) Transported person's first
name;
(E) Transported person's date
of birth in the format mm/dd/yyyy, if available;
(F) Transported person's pickup date in the
format mm/dd/yyyy;
(G) The name of
the delivered to facility; and
(H)
(I) The Glascow Coma Score and trauma
criteria as reported on the run report, or information using such other uniform
trauma reporting standards as the Department determines are reasonable and
necessary to accurately classify each trauma case.
(2) Financial information from the
free-standing ambulance financial records of the ambulance service including:
(A) Total reimbursement using the Medicare
allowed reimbursement or other methodology in place on the date of
transportation;
(B) Actual total
collections for the transported person's services as of the date the "Free
Standing Ambulance Service Revolving Fund Distribution Request Form" is
prepared by the trauma facility;
(C) Contractual adjustments pertinent to the
transportation services received by the transported person;
(D) The free-standing ambulance services
uncompensated care for the transported person calculated by subtracting the
figures in items (B) of this paragraph and (C) of this paragraph from the
amount in (A) of this paragraph.
(c) Each hospital-based ambulance service
shall, at a minimum, detail eligible trauma cases and summarize uncompensated
care in a format approved by the Department which includes the following:
(1) Demographic data extracted from the run
report including:
(A) Run report number or
lithocode;
(B) Transported person's
Social Security Number, if available;
(C) Transported person's last name;
(D) Transported person's first
name;
(E) Transported person's date
of birth in the format mm/dd/yyyy, if available;
(F) Transported person's pickup date in the
format mm/dd/yyyy;
(G) The name of
the delivered to facility; and
(H)
The Glascow Coma Score and trauma criteria as reported on the run report, or
information using such other uniform trauma reporting standards as the
Department determines are reasonable and necessary to accurately classify each
trauma case.
(2)
Financial information from the hospital-based ambulance financial records of
the ambulance service including:
(A) Total
reimbursement using the lesser of the Medicare per trip limit or the services'
charges multiplied by the hospital's ambulance department specific cost to
charge ratio;
(B) Actual total
collections for the transported person's services as of the date the is
prepared by the emergency medical service provider;
(C) Contractual adjustments pertinent to the
transportation services received by the transported person;
(D) The hospital-based ambulance services
uncompensated care for the transported person is calculated by subtracting the
figures in items (B) of this paragraph and (C) of this paragraph from the
amount in (A) of this paragraph.
(3) As an alternative to the report described
in (1) of this subsection, a hospital-based ambulance service may report using
a format approved by the Department by extracting from the trauma registry all
information the trauma facility reports and adding to that information the
ambulance-specific information from (1) of this subsection and (2) of this
subsection.
(d) It is
the responsibility of a physician submitting a claim for Trauma Fund
disbursement to validate the submission of trauma cases meeting the
requirements of
310:669-5-1
with the trauma registrar in the hospital in which the trauma care was
provided, and to submit eligible trauma cases and summarize uncompensated care
in a format approved by the Department which includes the following:
(1) Demographic data extracted from the
trauma registry including:
(A) Creation
number of the trauma registry entry;
(B) Patient's Social Security Number, if
available;
(C) Patient's date of
arrival at the trauma facility in the format mm/dd/yyyy;
(D) Patient date of birth in the format
mm/dd/yyyy, if available; and
(E)
Physical findings and treatment as specified in the Centers for Medicare and
Medicaid Services reimbursement methodology based on the appropriate procedure
code.
(2) Financial
information from the physician records including:
(A) Total allowable reimbursement using the
Medicare methodology in place on the date of care;
(B) Actual total collections for patient
services as of the date the request for revolving fund distribution is prepared
in a format approved by the Department;
(C) Contractual adjustments pertinent to the
services received by the patient;
(D) The physician's uncompensated care cost
calculated by subtracting the figures in items (B) of this paragraph; and (C)
of this paragraph from the amount in (A) of this paragraph.
(e) Each distribution
entity shall file with the appropriate request form a properly signed and
notarized contract in accordance with the Central Purchasing Act (74 O.S. Supp.
2000 Section 85.1 et seq.) to permit encumbrance by the State of the funds for
the distribution.
Added at 17 Ok Reg 3465,
eff 8-29-00 (emergency); Added at 18 Ok Reg 2047, eff 6-11-01; Amended at 21 Ok
Reg 2440, eff 7-11-05; Amended at 24 Ok Reg 2025, eff
6-25-07
