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Rev. ed. of: Mastering the reimbursement process / Curtis J. Udell, Susan E. Garrison, Deane R. Ferguson. 1996.
Due to the countless variables that affect revenue and cost, the hospital reimbursement process is by far the most complex of any industry. Requiring only a basic financial background and a working knowledge of accounting, Hospital Reimbursement: Concepts and Principles supplies a clear understanding of the concepts and principles that drive the revenue cycle within a hospital setting. The book explains the technical aspects of reimbursement in language that is easy to comprehend. It illustrates the complexities of the hospital revenue cycle and explains the Medicare and Medicaid financial models in detail. The text also addresses the Medicaid reimbursement methodology, the formulation of the Medicare blend rate, the computation of both DSH and IME, as well as other third-party payers. It also: Covers the full range of services and procedures for which a hospital can receive reimbursement Explains the difference between a for-profit and not-for-profit hospital Contains chapters devoted to Statements of Operations (Income Statement) and Statements of Financial Position (Balance Sheet) Examines governmental cost reporting—including Worksheets A, A-6, A-8, A-8-2, B-1, B Part 1, C Part 1, D-3, D-5, and E Part A Supplying readers with a foundation in coding principles, the text also includes a model for calculating the financial impact of variations in patient length of stay. It discusses the DRG and APC reimbursement models and details the computation of an outlier payment. In addition, it walks the reader step-by-step through the creation of a mock Medicare cost report for a sample hospital.
For courses in Medical Insurance, Medical Billing and Coding and Health Claims Reimbursement. Advanced Medical Billing and Coding: A Reimbursement Approach offers an innovative look at the complete billing, coding and medical claims reimbursement process. Its unique dual perspective considers the roles of the medical billing and coding professional and the health claims examiner. An extensive revision, this edition includes the new ICD-10 code set, the most current billing forms, and coverage of the most recent healthcare legislations. Four new chapters focus on processing medical claims for Non-Medicare, Medicare and Workers' Compensation. With its balanced perspective, students learn the perspectives of both the medical office and insurance company which prepares them for the complete billing, coding, and reimbursement cycle.
Health Care Finance and the Mechanics of Insurance and Reimbursement combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Updated throughout the Third Edition offers expanded material on financial statements; new and expanded Skilled Nursing Facility examples; and enhanced sections on PDPM, Practice Management for Primary Care and other Specialties, Clearinghouse Processes, Predictive Modeling (data mining), and more.
Tackle the issues of space capacity, utilization, patient flow and technology in this best-selling book for medical practice management.
Health Care Finance and the Mechanics of Insurance and Reimbursement stands apart from other texts on health care finance or health insurance, in that it combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle in detail, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Thoroughly updated for its second edition, this text reflects changes to the Affordable Care Act, Managed Care Organizations, new coding initiatives, new components of the revenue cycle (from reimbursement to compliance), updates to regulations surrounding health care fraud and abuse, changes to the Recovery Audit Contractors (RAC) program, and more.
This book was written to provide trainees with the knowledge and skills necessary to work in a variety of medical billing and coding positions in the medical field. Easy to read and comprehend, it is designed for professionals who have not previously worked in the medical field as well as professionals who have worked in the field but have only been exposed to certain aspects of the billing process. In order to adapt to the growing number of facilities that are becoming more automated, this book not only reviews non-automated procedures but it also gives in-depth content on automated procedures. A few exciting features to this book are: Case Studies with Critical Thinking Questions; a key terms list appears at the beginning of each chapter; Professional Tips appear throughout the text and provide additional information related to billing and coding processes; and any material within the text that is related to HIPAA is flagged with an icon so that students can identify the "need to know" law.