Trauma Collect, Inc.
In the world of workers’ compensation, trauma and emergency admissions sit at the crossroads of medicine and litigation.
Carriers see numbers. Hospitals see human lives — and unpaid bills.
Trauma Collect bridges that divide.
We specialize exclusively in high-acuity, high-denial cases —
where complexity, not compliance, drives the outcome.
Our portfolio includes California’s most respected names —
John Muir, Adventist Health, HCA/Parallon, Providence,
and Tri-City — each trusting us to convert denials into recoveries and confusion into clarity.
Three decades. One focus: turning chaos into compensation.
INTRODUCTION
In the world of workers’ compensation, trauma and emergency admissions sit at the crossroads of medicine and litigation.
Carriers see numbers. Hospitals see human lives — and unpaid bills.
Trauma Collect bridges that divide.
We specialize exclusively in high-acuity, high-denial cases — where complexity, not compliance, drives the outcome.
Our portfolio includes California’s most respected names — John Muir, Adventist Health, HCA/Parallon, Providence, and Tri-City — each trusting us to convert denials into recoveries and confusion into clarity.
Three decades.
One focus: turning chaos into compensation.
COMMON PROBLEMS HOSPITALS ENCOUNTER IN WORKERS’ COMP REIMBURSEMENT
Improper PPO Discounts:
Carriers apply discounts based on expired, irrelevant, or entirely fictional contracts — stripping legitimate claims of rightful value.
Misuse of the Fee Schedule:
Emergency, trauma, and pre-admission services are statutorily excluded from the OMFS — yet routinely capped as if they weren’t.
Bad-Faith Payment Delays:
When liability is clear, carriers stall — weaponizing time to pressure hospitals into “settlements” worth pennies on the dollar.
Carriers Exploitation:
They rely on fatigue — knowing one missed SBR or IBR deadline can erase the hospital’s right to additional
recovery. If any of these sound familiar, Trauma Collect can audit your existing workers’ comp claims an identify immediate recovery opportunities.
What looks like “process” is, too often, an obstacle.
REHABILITATION SERVICES: THE FEE SCHEDULE TRAP
When “Not Subject to Fee Schedule” Still Means Underpaid
It’s common knowledge that inpatient rehabilitation services are not governed by OMFS.
Hospitals should be paid their contracted rates:
$5,000 – $10,000 per day, or 60–80 % of billed charges.
Yet many carriers still pay only the DRG rate (≈ 10 %) and call it “maximum reimbursement.”
This isn’t confusion — it’s strategy.
They disguise lawful exemptions as negotiable discounts.
HOW THEY HIDE IT:
On the Explanation of Review (EOR) you’ll often see: “Contact your PPO Network for details.”
That harmless-looking line hides the real network name — often Anthem — outside the PPO field.
Here’s what happens:
Anthem’s “lesser of” language (billed vs. contract vs. fee schedule) is meant for group health, not workers’ comp.
Industrially related: emergency admission , burns and rehabilitation services are excluded from the fee schedule.
Anthem acts only as a contracting agent selling “discount access.” They are not the payor.
The carrier applies those reductions anyway, and both share in the “savings.”
While your billing team hunts for the missing PPO name, the 90-day SBR window closes.
The appeal is gone — and so is the money.
THE SBR/IBR PROCESS
(HOW THE SYSTEM IS BUILT TO DELAY)
1️⃣ Second Bill Review: Once a payment is Received if unsatisfactory, the provider has 90 days to appeal.
If payment is unsatisfactory the medical provider has 90 days to submit an appeal.
If the provider responds with “We don’t owe you any more money” : otherwise known as Final EOR.
Trauma collect will represent the Hospital at Any one of the 17 workers compensation appeals boards or proceed to Maximus Independent Bill Reviewers (IBR).
If final EOR is unchanged → you have 30 days to file with Maximus IBR.
2️⃣ Independent Bill Review (IBR) filed with Maximus IBR ($195 fee).
3️⃣ The Trap Vague or redacted EORs burn up the clock.
By the time you discover the error, the SBR deadline has expired.
KEY BENEFITS OF TRAUMA COLLECT
Maximizes Revenue Recovery for Hospitals
Our specialized team identifies every underpaid or overlooked opportunity within the workers’ compensation system — from trauma activations to high-acuity admissions — ensuring hospitals receive the full reimbursement they’ve earned. Every claim is treated like a recovery mission, not just a billing process.
Deep Expertise in Trauma & Emergency Admissions
We live and breathe trauma. From activation fees and preadmission services to complex post-surgical stays, our experience allows us to navigate California’s labyrinthine fee schedule and carve out what’s truly exempt and payable.
We turn chaos into compliance — and compliance into cash.
Works Alongside Existing Vendors Without Interference
We’re collaborators, not competitors. Trauma Collect integrates seamlessly with your existing billing, early-out, and legal vendors — providing targeted support for complex workers’ comp claims while keeping your internal systems and teams intact. Think of us as the trauma unit for your AR.
Strictly Contingency-Based Engagement
No hourly fees. No retainers. No surprises…
We get paid when you do — aligning our incentives perfectly with yours.
If there’s no recovery, there’s no cost. A simple, transparent, performance-driven strategic partnership.
FULL CIRCLE: FROM DENIAL TO RECOVERY
(BALANCED PROFESSIONAL)
Over three decades, Trauma Collect has redefined what recovery means in California workers’ compensation.
We’ve shown that when hospitals stand their ground — armed with the right expertise — denials become recoveries and confusion becomes clarity.
Our work is simple in principle but powerful in outcome: to make sure no hospital stands alone when a claim goes…
silent.
Let’s connect, review your most complex admissions, and reclaim the value that’s been sidelined.
PROFESSIONAL ACCOUNTABILITY & CONFIDENTIALITY
TRAUMA COLLECT, INC. and its Hearing Representatives are authorized to appear before the California Workers’
Compensation Appeals Board (WCAB) under Labor Code § 4907, which provides:
“The privilege of any person, other than an attorney admitted to practice… may, after hearing, be removed, denied, or suspended by the appeals board for violation of this chapter, or of the rules… or for other good cause.” (Labor Code § 4907(a))
“For purposes of this section, non-attorney representatives shall be held to the same professional standards of conduct as attorneys.”
(Labor Code § 4907(b))
Key Points:
Trauma Collect is bound by law to the same professional and confidentiality standards as attorneys.
Each representative must maintain integrity, discretion, and full compliance with all WCAB and HIPAA requirements.
This ensures accountability, transparency, and trust in every matter handled on behalf of our hospital partners.
In short:
Your hospital’s data is protected, your patients’ records remain confidential, and your trust is safeguarded by law.
DATA SECURITY & HIPAA COMPLIANCE
TRAUMA COLLECT INC. maintains strict safeguards for all Protected Health Information (PHI) related to workers’ compensation claims.
45 C.F.R. § 164.530(c)(1): “A covered entity must have appropriate administrative, technical, and physical safeguards to protect the privacy of PHI.”
45 C.F.R. § 164.512(l): “A covered entity may disclose PHI as authorized by and to the extent necessary to comply with laws relating to workers’ compensation…”
Safeguards:
🔐 AES-256 Encryption on all devices and cloud storage.
☁️ HIPAA-compliant servers with restricted, role-based access.
🧩 Multi-Factor Authentication and password protection.
📜 Mandatory HIPAA agreements for all representatives.
Clarification for Hospitals:
Even if a device were lost or compromised, all PHI remains encrypted, unreadable, and inaccessible.
Because workers’ comp disclosures are expressly authorized under 45 C.F.R. § 164.512(l), and encrypted data is excluded
from breach reporting under 45 C.F.R. § 164.402(2), such an event would not constitute a HIPAA violation.
Bottom Line:
Your hospital’s data stays secure, compliant, and protected by design and by law
