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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...
| Clasificación: | Libro Electrónico |
|---|---|
| Autor principal: | |
| Formato: | Electrónico eBook |
| Idioma: | Inglés |
| Publicado: |
Boca Raton, Fla. :
CRC Press,
©2013.
|
| Colección: | Healthcare payment systems.
|
| Temas: | |
| Acceso en línea: | Texto completo (Requiere registro previo con correo institucional) |
MARC
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| 100 | 1 | |a Abbey, Duane C. | |
| 245 | 1 | 0 | |a Cost-based, charge-based, and contractual payment systems / |c Duane C. Abbey. |
| 260 | |a Boca Raton, Fla. : |b CRC Press, |c ©2013. | ||
| 300 | |a 1 online resource | ||
| 336 | |a text |b txt |2 rdacontent | ||
| 337 | |a computer |b c |2 rdamedia | ||
| 338 | |a online resource |b cr |2 rdacarrier | ||
| 490 | 1 | |a Healthcare payment systems | |
| 500 | |a "A Productivity Press book." | ||
| 500 | |a Title from title screen. | ||
| 504 | |a Includes bibliographical references and index. | ||
| 505 | 0 | |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 | |
| 505 | 0 | |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 | |
| 505 | 0 | |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 | |
| 505 | 0 | |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 | |
| 505 | 0 | |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 | |
| 520 | |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"-- |c Provided by publisher | ||
| 590 | |a O'Reilly |b O'Reilly Online Learning: Academic/Public Library Edition | ||
| 650 | 0 | |a Medical fees |z United States. | |
| 650 | 0 | |a Health insurance claims |z United States. | |
| 650 | 1 | 2 | |a Reimbursement Mechanisms |
| 650 | 2 | 2 | |a Contract Services |
| 651 | 2 | |a United States | |
| 650 | 6 | |a Médecins |x Honoraires |z États-Unis. | |
| 650 | 6 | |a Assurance-maladie |x Demandes de règlement |z États-Unis. | |
| 650 | 7 | |a BUSINESS & ECONOMICS |x Industries |x General. |2 bisacsh | |
| 650 | 7 | |a Health insurance claims. |2 fast |0 (OCoLC)fst00953087 | |
| 650 | 7 | |a Medical fees. |2 fast |0 (OCoLC)fst01014114 | |
| 651 | 7 | |a United States. |2 fast |0 (OCoLC)fst01204155 | |
| 776 | 0 | 8 | |i Print version: |a Abbey, Duane C. |t Cost-based, charge-based, and contractual payment systems. |d Boca Raton : CRC Press, ©2013 |z 9781439872994 |w (DLC) 2012013464 |w (OCoLC)783990850 |
| 830 | 0 | |a Healthcare payment systems. | |
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