Cost-based, charge-based, and contractual payment systems. (©2013)

• Record Type: Book
• Further Information: Note: Duane C. Abbey.
• Other Names: Abbey, Duane C
• Contents: Introduction; Preliminary Comments; Review 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 Systems; Healthcare Provider Concepts; Physicians; Nonphysician Practitioners and Providers; Clinics; Hospitals; 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; Claim Adjudication and Payment Processing; Summary and Conclusion; Healthcare Provider Costs and Cost-Based Payment Systems; Introduction; Costs and Cost Accounting; Medicare Cost Report; Cost-Based Payment: Key Features; Critical Access Hospitals; Rural Health Clinics and Federally Qualified Health Centers; Summary and Conclusion Healthcare Provider Charges and Charge-Based Payment Systems; Introduction; Charge-Based Payment: Key Features; Charge Structures for Healthcare Providers; Healthcare Pricing Strategies; Chargemasters for Hospitals and Integrated Delivery Systems; Charge CompressionMedicare Charging Rule; Healthcare Provider Charges and Public Scrutiny; Summary and Conclusion Contractual Payment Systems; Introduction; HIPAA Transaction Standards; Managed Care Organizations; Terminology 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 Audits; Negotiating and Analyzing MCO Contracts; Precontract Data Gathering; Contract and Relationship Analysis; Financial Analysis and Modeling; Operational Monitoring; Renewal and Termination; Medicare Advantage Plans; Summary and Conclusion Capitated Payment Systems; Introduction; Capitation: Key Features; Risk Management through Insurance; Models for Capitation; Summary and Conclusion Claim Adjudication and Compliance; Introduction; Statutory versus Contractual Compliance; Audits and Reviews; Types of Audits; Audit Process; Extrapolation Process; Audit Reports; Audit Dependence on Payment Mechanism; Claim Modification Issues; A Systematic Approach to Compliance; Secondary-Payer Issues; Healthcare Provider Credentialing; Summary and Conclusion Summary, Conclusion, and the Future; Healthcare Payment Systems: A Historical Perspective; Extreme Variability in Payment Systems; Compliance Issues; Payment Systems: The Future; Endnote List of Acronyms Appendix: Synopsis of the Medicare Program’s Payment Systems; Appendix: Case Study List Index
• Publisher Details: Boca Raton, Fla : CRC Press
• Publication Date: 2013
• Copyright Date: 2013
• Extent: 1 online resource
• Subjects: 338.4/73621; Medical fees -- United States; Health insurance claims -- United States; BUSINESS & ECONOMICS -- Industries -- General; Health insurance claims; Medical fees; United States; Electronic books
• Languages: English
• ISBNs: 9781439873007; 1439873003
• Related ISBNs: 9781466539600; 1466539607; 9781466578777; 1466578777; 9781439872994; 1439872996
• Notes: Note: Includes bibliographical references and index.
• 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.