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05221nmm a2200577 u 4500 |
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EBX01000000000000001078262 |
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210123 ||| eng |
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|a 9781439873007
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|a 1439873003
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4 |
|a R728.5
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| 100 |
1 |
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|a Abbey, Duane C.
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| 245 |
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|a Cost-based, charge-based, and contractual payment systems
|c Duane C. Abbey
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| 260 |
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|a Boca Raton, Fla.
|b CRC Press
|c 2013
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| 300 |
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|a 1 online resource
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| 505 |
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|a 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
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|a Includes bibliographical references and index
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|a 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
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| 505 |
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|a 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
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| 505 |
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|a 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
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| 505 |
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|a 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
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| 653 |
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|a BUSINESS & ECONOMICS / Industries / General / bisacsh
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| 653 |
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|a Reimbursement Mechanisms
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| 653 |
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|a Health insurance claims / fast
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| 653 |
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|a United States / fast / https://id.oclc.org/worldcat/entity/E39PBJtxgQXMWqmjMjjwXRHgrq
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| 653 |
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|a Assurance-maladie / Demandes de règlement / États-Unis
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| 653 |
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|a Médecins / Honoraires / États-Unis
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| 653 |
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|a United States
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| 653 |
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|a Health insurance claims / United States
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| 653 |
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|a Medical fees / fast
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| 653 |
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|a Medical fees / United States
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| 653 |
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|a Contract Services
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| 041 |
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7 |
|a eng
|2 ISO 639-2
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| 989 |
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|b OREILLY
|a O'Reilly
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| 490 |
0 |
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|a Healthcare payment systems
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| 500 |
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|a "A Productivity Press book.". - Title from title screen
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| 015 |
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|a GBB8E3770
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| 776 |
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|z 1466578777
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| 776 |
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|z 1439873003
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| 776 |
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|z 9781466578777
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| 776 |
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|z 1466539607
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| 776 |
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|z 9781439873007
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| 776 |
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|z 1439872996
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| 776 |
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|z 9781466539600
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| 776 |
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|z 9781439872994
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| 856 |
4 |
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|u https://learning.oreilly.com/library/view/~/9781439872994/?ar
|x Verlag
|3 Volltext
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| 082 |
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|a 330
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| 082 |
0 |
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|a 338.4/73621
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| 520 |
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|a "This book provides an overview of a wide range of healthcare payment systems. It compares cost-based systems, charge-based payment approaches, and contractually-based payment processes to fee-schedule payment systems and prospective payment systems. It covers claim adjustment and compliance as well as managed care contracts and various combinations of payment systems used by third-party administrators. Examples illustrate the processes used for capitated contract arrangements. The author also addresses various compliance issues, including statutory, contractual, and overpayment issues"--
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