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abbey duane c. - cost-based, charge-based, and contractual payment systems

Cost-Based, Charge-Based, and Contractual Payment Systems




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Dettagli

Genere:Libro
Lingua: Inglese
Pubblicazione: 08/2012
Edizione: 1° edizione





Note Editore

The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important background material on the different types of healthcare providers, it covers the basics of cost-based, charge-based, and contractual payment systems. The book illustrates essential concepts with a series of simple case studies—making it ideal for anyone interested in learning more about the specific systems and processes used for payment in healthcare services. It discusses Medicare cost-based payment systems, Medicare payment approaches, and includes an appendix that outlines the various Medicare payment systems. Demystifying contractual language, it outlines managed care contracts and also: Delves into the intricacies involved with adjudication of claims Considers capitated payment systems Addresses healthcare costs and cost-based reimbursement systems Examines charge-based and contractual payment systems Describes where healthcare payment systems are headed in the future Since compliance is inherent throughout the process of providing services, filling claims, and receiving payment, the book examines the range of compliance concerns, including statutory, contractual, and overpayment issues. Using numerous examples to illustrate the processes used for capitated contract arrangements, the book includes coverage of claim adjustment, managed care contracts, and the various combinations of payment systems used by third-party administrators.




Sommario

IntroductionPreliminary CommentsReview of Healthcare Payment Systems Claims Filing and Payment Deductibles and Copayments Fee Schedule Payment Systems Prospective Payment Systems Cost-Based Payment Systems Charge-Based Payment Systems Capitation Payment Systems Contractual Payment SystemsHealthcare Provider Concepts Physicians Nonphysician Practitioners and Providers Clinics HospitalsHospitals and Integrated Delivery Systems Special Provider Organizations DME Suppliers Skilled Nursing Facilities Home Health Agencies Independent Diagnostic Testing Facilities Comprehensive Outpatient Rehabilitation Facilities Clinical Laboratories Ambulatory Surgical CentersClaim Adjudication and Payment ProcessingSummary and Conclusion Healthcare Provider Costs and Cost-Based Payment SystemsIntroductionCosts and Cost AccountingMedicare Cost ReportCost-Based Payment: Key FeaturesCritical Access HospitalsRural Health Clinics and Federally Qualified Health CentersSummary and Conclusion Healthcare Provider Charges and Charge-Based Payment SystemsIntroductionCharge-Based Payment: Key Features Charge Structures for Healthcare Providers Healthcare Pricing StrategiesChargemasters for Hospitals and Integrated Delivery Systems Charge CompressionMedicare Charging Rule Healthcare Provider Charges and Public ScrutinySummary and Conclusion Contractual Payment SystemsIntroductionHIPAA Transaction StandardsManaged Care OrganizationsTerminology and Contract Features Definitions Reimbursement and Payment Terms Provision of Services Payer and Payee Obligations Payment Mechanisms Credentialing Processes Medical Necessity and Coverage Issues Administrative Proceedings Access to Records and AuditsNegotiating and Analyzing MCO Contracts Precontract Data Gathering Contract and Relationship Analysis Financial Analysis and Modeling Operational Monitoring Renewal and TerminationMedicare Advantage PlansSummary and Conclusion Capitated Payment SystemsIntroductionCapitation: Key FeaturesRisk Management through InsuranceModels for CapitationSummary and Conclusion Claim Adjudication and ComplianceIntroductionStatutory versus Contractual ComplianceAudits and Reviews Types of Audits Audit ProcessExtrapolation Process Audit Reports Audit Dependence on Payment Mechanism Claim Modification IssuesA Systematic Approach to ComplianceSecondary-Payer IssuesHealthcare Provider CredentialingSummary and Conclusion Summary, Conclusion, and the FutureHealthcare Payment Systems: A Historical PerspectiveExtreme Variability in Payment SystemsCompliance IssuesPayment Systems: The FutureEndnote List of Acronyms Appendix: Synopsis of the Medicare Program’s Payment SystemsAppendix: Case Study List Index




Autore

Duane C. Abbey










Altre Informazioni

ISBN:

9781439872994

Condizione: Nuovo
Collana: Healthcare Payment Systems
Dimensioni: 10 x 7 in Ø 0.75 lb
Formato: Brossura
Illustration Notes:3 b/w images and 2 tables
Pagine Arabe: 181


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