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Author: Kyle Herbert Publisher: CRC Press ISBN: 1439898944 Category : Business & Economics Languages : en Pages : 275
Book Description
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.
Author: Michael K. Harrington Publisher: Jones & Bartlett Learning ISBN: 1284169030 Category : Medical Languages : en Pages : 344
Book Description
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.
Author: AAPC Publisher: AAPC ISBN: 1626889821 Category : Medical Languages : en Pages : 16
Book Description
Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more!
Author: Wolters Kluwer Law & Business Health Editorial Publisher: Wolters Kluwer ISBN: 0808040049 Category : Business & Economics Languages : en Pages : 1642
Book Description
The 2015 Master Medicare Guide is a one-volume desk reference packed with timely and useful information for providers, attorneys, accountants, and consultants who need to stay on top of one of the most complex programs maintained by the federal government.
Author: Elaine Stattler Publisher: John Wiley & Sons ISBN: 0996729321 Category : Business & Economics Languages : en Pages : 565
Book Description
The essential guide for today’s savvy controllers Today’s controllers are in leadership roles that put them in the unique position to see across all aspects of the operations they support. The Master Guide to Controllers’ Best Practices, Second Edition has been revised and updated to provide controllers with the information they need to successfully monitor their organizations’ internal control environments and offer direction and consultation on internal control issues. In addition, the authors include guidance to help controllers carryout their responsibilities to ensure that all financial accounts are reviewed for reasonableness and are reconciled to supporting transactions, as well as performing asset verification. Comprehensive in scope the book contains the best practices for controllers and: Reveals how to set the right tone within an organization and foster an ethical climate Includes information on risk management, internal controls, and fraud prevention Highlights the IT security controls with the key components of successful governance Examines the crucial role of the controller in corporate compliance and much more The Master Guide to Controllers’ Best Practices should be on the bookshelf of every controller who wants to ensure the well-being of their organization. In addition to their traditional financial role, today’s controllers (no matter how large or small their organization) are increasingly occupying top leadership positions. The revised and updated Second Edition of The Master Guide to Controllers’ Best Practices provides an essential resource for becoming better skilled in such areas as strategic planning, budgeting, risk management, and business intelligence. Drawing on the most recent research on the topic, informative case studies, and tips from finance professionals, the book highlights the most important challenges controllers will face. Written for both new and seasoned controllers, the Guide offers a wide range of effective tools that can be used to improve the skills of strategic planning, budgeting, forecasting, and risk management. The book also contains a resource for selecting the right employees who have the technical knowledge, analytical expertise, and strong people skills that will support the controller’s role within an organization. To advance overall corporate performance, the authors reveal how to successfully align strategy, risk management, and performance management. In addition, the Guide explains what it takes to stay ahead of emerging issues such as healthcare regulations, revenue recognition, globalization, and workforce mobility. As controllers adapt to their new leadership roles and assume more complex responsibilities, The Master Guide to Controllers’ Best Practices offers an authoritative guide to the tools, practices, and ideas controllers need to excel in their profession.
Author: Deborah Walker Keegan Publisher: Medical Group Management Association/Center for Research in Ambulatory Health Care Administration ISBN: 9781568294940 Category : Medical Languages : en Pages : 421
Book Description
This third edition of the MGMA bestseller on physician billing process and revenue cycle management is a completely revised, comprehensive manual. Delivering proven solutions to optimize your revenue cycle, this professional fee billing primer is business-critical whether you're new to managing the revenue cycle or a seasoned professional.
Author: Marsha Diamond Publisher: Elsevier Health Sciences ISBN: 0323277632 Category : Medical Languages : en Pages : 841
Book Description
Expansion of ICD-9-CM information. - Sample patient charts include explanatory notes. - A simulated medical practice (identified as Godfrey Regional) lets you study in a real-world scenario. - Key Terms lists highlight the most important vocabulary and content. - More exercises!
Author: Duane C. Abbey Publisher: CRC Press ISBN: 1439872996 Category : Business & Economics Languages : en Pages : 186
Book Description
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.
Author: L. Lamar Blount
Author: L. Lamar Blount
Author: Curtis J. Udell
Author: Kyle Herbert
Author: Michael K. Harrington
Author: AAPC
Author: Wolters Kluwer Law & Business Health Editorial
Author: Elaine Stattler
Author: Deborah Walker Keegan
Author: Marsha Diamond
Author: Duane C. Abbey