Cost-based, charge-based, and contractual payment systems
"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...
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| Format: | eBook |
| Language: | English |
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Boca Raton, Fla.
CRC Press
2013
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| Series: | Healthcare payment systems
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| Online Access: | |
| Collection: | O'Reilly - Collection details see MPG.ReNa |
Table of Contents:
- 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
- Includes bibliographical references and index
- 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
- 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
- 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
- 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