Author : Duane C. Abbey
Publisher : CRC Press
Page : 186 pages
File Size : 28,29 MB
Release : 2018-06-28
Category : Business & Economics
ISBN : 1040084044
The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important backgr
Author : Duane C. Abbey
Publisher : CRC Press
Page : 179 pages
File Size : 48,51 MB
Release : 2018-06-28
Category : Business & Economics
ISBN : 1439873003
The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important backgr
Author : Duane C. Abbey
Publisher : CRC Press
Page : 186 pages
File Size : 17,16 MB
Release : 2012-08-07
Category : Business & Economics
ISBN : 1439872996
The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important background material on the different types of healthcare providers, it covers the basics of cost-based, charge-based, and contractual payment systems. The book illustrates essential concepts with a series of simple case studies—making it ideal for anyone interested in learning more about the specific systems and processes used for payment in healthcare services. It discusses Medicare cost-based payment systems, Medicare payment approaches, and includes an appendix that outlines the various Medicare payment systems. Demystifying contractual language, it outlines managed care contracts and also: Delves into the intricacies involved with adjudication of claims Considers capitated payment systems Addresses healthcare costs and cost-based reimbursement systems Examines charge-based and contractual payment systems Describes where healthcare payment systems are headed in the future Since compliance is inherent throughout the process of providing services, filling claims, and receiving payment, the book examines the range of compliance concerns, including statutory, contractual, and overpayment issues. Using numerous examples to illustrate the processes used for capitated contract arrangements, the book includes coverage of claim adjustment, managed care contracts, and the various combinations of payment systems used by third-party administrators.
Author : David B. Humphrey
Publisher : World Bank Publications
Page : 114 pages
File Size : 34,6 MB
Release : 1995
Category : Business & Economics
ISBN : 9780821331118
World Bank Technical Paper No. 260. An efficient payment system is a necessary precondition for business development. This study outlines the basic operating principles of a payment system and reviews its benefits, costs, risks, and problems. It examines in detail the systems currently in place in the developed economies of Europe and the United States and draws from the analyses to support recommendations for restructuring those systems in developing countries. The study reviews the various types of payment practices that exist in mature systems including cash, check, GIRO, debit and credit card, direct debit, and large-value wire transfers. A range of short- and long-term improvements in payment systems are recommended for developing countries. There is a special focus on the Russian payment system and the problems it faces in transition from a centrally planned to an market economy.
Author : Darrell J. Oyer
Publisher : Berrett-Koehler Publishers
Page : 393 pages
File Size : 11,48 MB
Release : 2012-10
Category : Business & Economics
ISBN : 1523097159
This master reference is essential if you contract with the government! Correctly pricing your goods or services—and making certain that those prices are in compliance with myriad federal rules and regulations—is essential to doing business with the government…and ensuring your commercial success. Cost-Based Pricing: A Guide for Government Contractors shows you how to appropriately estimate and price for government contracts and defend those estimates in a government contracting and subcontracting environment. This practical book includes coverage of all government pricing rules and regulations as well as pertinent aspects of related laws, such as the Truth in Negotiations Act. The book walks you through every step of the estimating process. From figuring direct labor costs to intra-company transfers to contract modifications, the coverage is extensive yet accessible for even those new to the process. Using Cost-Based Pricing, you will be able to: • Develop more realistic estimates • Enhance your support of those estimates in negotiations • Avoid violations of the Truth in Negotiations Act • Increase your chances of securing a fair and reasonable price Cost-Based Pricing: A Guide for Government Contractors can make the difference between your success—and profitability—and failure in the federal government arena.
Author : Institute of Medicine
Publisher : National Academies Press
Page : 261 pages
File Size : 20,81 MB
Release : 2000-12-04
Category : Medical
ISBN : 0309183618
Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.
Author : Alan L. Tyree
Publisher : Butterworths
Page : 206 pages
File Size : 28,24 MB
Release : 2000
Category : Consumer credit
ISBN : 9780409317015
This work focuses on the changes and demands of new electronic payment systems. Two sections cover the main elements of the Australian payment systems and its governing law and a discussion of case studies with an emphasis on drafting contracts.
Author : Institute of Medicine
Publisher : National Academies Press
Page : 359 pages
File Size : 19,77 MB
Release : 2001-07-19
Category : Medical
ISBN : 0309132967
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Author : Duane C. Abbey
Publisher : CRC Press
Page : 232 pages
File Size : 10,33 MB
Release : 2008-04-02
Category : Medical
ISBN : 1563273683
While the vast majority of providers never intend to commit fraud or file false claims, complex procedures, changing regulations, and evolving technology make it nearly impossible to avoid billing errors. For example, if you play by HIPAA’s rules, a physician is a provider; however, Medicare requires that the same physician must be referred to as a supplier. Even more troubling is the need to alter claims to meet specific requirements that may conflict with national standards. Far from being a benign issue, differing guidelines can lead to false claims with financial and even criminal implications. Compliance for Coding, Billing & Reimbursement, Second Edition: A Systematic Approach to Developing a Comprehensive Program provides an organized way to deal with the complex coding, billing, and reimbursement (CBR) processes that seem to force providers to choose between being paid and being compliant. Fully revised to account for recent changes and evolving terminology, this unique and accessible resource covers statutorily based programs and contract-based relationships, as well as ways to efficiently handle those situations that do not involve formal relationships. Based on 25 years of direct client consultation and drawing on teaching techniques developed in highly successful workshops, Duane Abbey offers a logical approach to CBR compliance. Designed to facilitate efficient reimbursements that don’t run afoul of laws and regulations, this resource – Addresses the seven key elements promulgated by the OIG for any compliance program Discusses numerous types of compliance issues for all type of healthcare providers Offers access to online resources that provide continually updated information Cuts through the morass of terminology and acronyms with a comprehensive glossary Includes a CD-ROM packed with regulations and information In addition to offering salient information illustrated by case studies, Dr, Abbey provides healthcare providers and administrators, as well as consultants and attorneys, with the mindset and attitude required to meet this very real challenge with savvy, humor, and perseverance.
Author : Caryn Bredenkamp
Publisher : World Bank Publications
Page : 69 pages
File Size : 22,25 MB
Release : 2019-12-19
Category : Medical
ISBN : 1464815216
This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.
