Prospective payment systems. (2012)

• Record Type: Book
• Further Information: Note: By Duane C. Abbey.
• Other Names: Abbey, Duane C
• Contents: Introduction to Prospective Payment Systems; Preliminary Comments; Overview of Healthcare Payment Systems; Claims Filing and Payment; Deductibles and Copayments; Overview of Medicare Prospective Payment Systems; Private Third-Party Payer and Prospective Payment Systems; Payment System Interfaces; Healthcare Provider Use of Prospective Payment Systems to Set Charges; Summary and Conclusion Healthcare Provider Concepts; Introduction; Physicians; Non-Physician Practitioners and Providers; Clinics; Hospitals; Special Hospitals with Specialized Prospective Payment Systems; Hospitals 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 Centers; Summary and Conclusion Anatomy of a Prospective Payment System; Introduction; Necessary Elements; PPS Coverage; PPS Unit of Service; PPS Classification Systems; Developing Categories or Groups; Determining Payment Amounts; Unusual Circumstances for Additional Payments; Special Incentives/Constraints; Coding for PPSs; Cost Reports; Hospital Chargemasters; Relative Weights; Conversion Factor; Chapter Summary Medicare Severity Diagnosis Related Groups (MS-DRGs); Introduction; Terminology; Historical Background; MS-DRG Design Features; Coverage; Unit of Service; Classification System; MS-DRG Categories; MS-DRG Grouping; MS-DRG Relative Weights; Case-Mix Index (CMI); ICD-10 Coding: The Key for Optimizing MS-DRG Reimbursement; Conversion of M-DRGs to MS-DRGs; Payment Process; Transfers; Cost Outliers; Special Types and Designations of Hospitals; Documentation Features; Additional Features for MS-DRGs; 3-Day Preadmission Window; Post-Acute Care Transfer; Present on Admission (POA); Updating Process for MS-DRGs; Variations of DRGs; Compliance Considerations; Quality Initiatives and Electronic Health Records; Summary and Conclusion Ambulatory Payment Classifications (APCs); Introduction; Historical Background; Challenges for Hospital Outpatient Prospective Payment; Ambulatory Patient Groups (APGs); Three-Day Window of Service; Significant Procedure Consolidation; E/M Service Bundling; APC Design and Implementation Parameters; Medicare APC Coverage; Encounter Driven; APC Classification Systems: CPT and HCPCS; CPT Codes and Modifiers; HCPCS Codes and Modifiers; National Correct Coding Initiative (NCCI) Edits; APC Status Indicators (Sis); Packaging; Composite APCs; Discounting; Global Surgical Package (GSP); Payment under APCs; Special Payment Considerations; APC Grouper/Pricer; Deductibles and Copayments; The Provider-Based Rule; Provider-Based Clinics; Split Billing: 1500 plus UB-04; Establishing Fee Schedules; Billing Privileges; Special Situations; Ambulatory Surgical Centers; Payment System Interfaces for APCs; APCs and the Federal Register Process; Quality Reporting and Compliance for APCs; Summary and Conclusion Other Prospective Payment Systems; Introduction; Skilled Nursing Facilities (SNFs); Coverage; Classification and Grouping; SNF Payment; SNF Issues; Home Health; Coverage; Unit of Service/Unit of Payment; Classification/Grouping; Home Health Payment; Long-Term Care Hospitals (LTCHs); Coverage; Classification and Grouping for LTCHs; MS-LTC-DRG Pricer; Other Features for the LTCH-PPS; Inpatient Rehabilitation Facilities; Inpatient Psychiatric Facilities (IPFs); End-Stage Renal Dialysis (ESRD); Private Third-Party Payer Utilization of PPSs; Summary and Conclusion Conclusion and Endnote Appendix A: Case Studies; Chapter 1 Case Studies; Chapter 2 Case Studies; Chapter 3 Case Studies; Chapter 4 Case Studies; Chapter 5 Case Studies; Chapter 6 Case Studies Appendix B: Acronyms
• Publisher Details: Place of publication not identified : CRC Press
• Publication Date: 2012
• Extent: 1 online resource (219 pages), (4 illustrations)
• Subjects: 368.382; Medical fees; Health insurance claims
• Languages: English
• ISBNs: 9781466553774; 1466553774
• Access Rights: Legal Deposit; Only available on premises controlled by the deposit library and to one user at any one time; The Legal Deposit Libraries (Non-Print Works) Regulations (UK).
• Access Usage: Restricted: Printing from this resource is governed by The Legal Deposit Libraries (Non-Print Works) Regulations (UK) and UK copyright law currently in force.