Principles of Healthcare Reimbursement


Book Description

The sixth edition of Principles of Healthcare Reimbursement gives educators, students, and healthcare professionals comprehensive, up-to-date information on healthcare reimbursement systems, and the impact each system has on the entire US healthcare delivery system and economy, in one trusted source. In addition to describing healthcare reimbursement methodologies and systems, this text discusses the impact of health insurance, coding and billing compliance and value-based purchasing initiatives. New and future healthcare professionals desiring to work in healthcare finance, revenue cycle, compliance and coding will gain the knowledge and training they need to succeed. Key Features include: New 4-color interior design! -- Covers accessing and using fee schedules, payment classification groups, exclusion lists, market baskets, and wage indexes required for accurate reimbursement -- Explains the various methods, plans, and programs that typify government-sponsored payment systems, commercial insurance, and managed-care -- Describes various types of healthcare cost-sharing and their effects on providers and consumers -- Illustrates specialized data collection instruments and electronic submission software used in postacute care -- Provided by publisher.




Health Care Finance and the Mechanics of Insurance and Reimbursement


Book Description

Health Care Finance and the Mechanics of Insurance and Reimbursement stands apart from other texts on health care finance or health insurance, in that it combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle in detail, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Thoroughly updated for its second edition, this text reflects changes to the Affordable Care Act, Managed Care Organizations, new coding initiatives, new components of the revenue cycle (from reimbursement to compliance), updates to regulations surrounding health care fraud and abuse, changes to the Recovery Audit Contractors (RAC) program, and more.







Medical Revenue Cycle Management - The Comprehensive Guide


Book Description

This essential guide dives deep into the intricacies of Medical Revenue Cycle Management (MRCM), offering healthcare professionals, administrators, and students a clear roadmap to mastering the financial backbone of healthcare services. In a landscape where financial health is as critical as patient health, this book stands out by providing a meticulously researched, expertly written exploration of every phase of the revenue cycle—from patient registration to the final payment of balances. Without relying on images or illustrations, we navigate through complex regulations, coding challenges, and billing practices with clarity and precision, making this complex subject accessible and actionable. Our unique approach combines theoretical frameworks with practical, real-world applications, setting this book apart as a must-buy. We delve into innovative strategies for optimizing revenue, reducing denials, and enhancing patient satisfaction, all while maintaining compliance with evolving healthcare laws and regulations. By focusing on efficiency and effectiveness, we equip readers with the tools and insights needed to transform their revenue cycle processes. Whether you're looking to refine your current practices or build a foundation of knowledge from the ground up, this guide offers invaluable insights into achieving financial stability and success in the ever-changing world of healthcare.




MEDICAL REVENUE CYCLE MANAGEMENT - One Book To Make You Genius


Book Description

Medical Revenue Cycle Management: One Book To Make You Genius by VIRUTI SHIVAN Are you a student aspiring to excel in the complex world of medical revenue cycle management? Look no further! This comprehensive guide is tailor-made to equip you with the knowledge and skills necessary to navigate the intricacies of this vital healthcare discipline. Medical Revenue Cycle Management: One Book To Make You Genius is a must-have resource that covers every aspect of the revenue cycle process, from patient registration to claim reimbursement. Written with students in mind, this book offers a comprehensive overview of the subject, providing a solid foundation for your future career. Inside this guide, you will find: 1. Introduction to Medical Revenue Cycle Management: Gain a clear understanding of the revenue cycle and its significance in healthcare organizations. Explore the various roles and responsibilities involved in revenue cycle management. 2. Patient Access and Registration: Learn the fundamentals of patient registration, insurance verification, and the importance of accurate patient data collection. Understand the impact of accurate information on revenue optimization. 3. Health Insurance and Payer Systems: Explore the intricacies of health insurance, different types of payers, and their impact on revenue cycle management. Gain insights into payer contracts, claim submission, and electronic data interchange (EDI). 4. Coding and Documentation: Discover the importance of accurate medical coding and its impact on reimbursement. Master the principles of coding, documentation guidelines, and coding systems such as ICD-10-CM and CPT. 5. Claims Management and Denial Resolution: Delve into the world of claims management, including claim submission, tracking, and denial resolution. Learn effective strategies to minimize claim denials and maximize revenue recovery. 6. Billing and Reimbursement: Understand the intricacies of billing processes, including charge capture, pricing, and electronic billing systems. Explore reimbursement methodologies, such as fee-for-service and value-based reimbursement. 7. Compliance and Regulatory Considerations: Stay up to date with the ever-evolving healthcare regulations and compliance requirements. Learn about HIPAA, fraud and abuse laws, and the importance of ethical billing practices. 8. Key Performance Indicators and Revenue Cycle Analytics: Gain insights into tracking and measuring revenue cycle performance through key performance indicators (KPIs) and analytics. Learn to identify areas for improvement and optimize revenue generation. With its student-friendly approach, practical examples, and case studies, this guide ensures that you not only grasp the theoretical concepts but also develop the critical thinking and problem-solving skills necessary for success in this field. Whether you are a healthcare administration student, aspiring medical coder, or revenue cycle professional, this comprehensive guide will serve as your go-to reference, providing you with a solid foundation in medical revenue cycle management. Unlock your potential and embark on a successful career in this crucial area of healthcare administration with confidence! Don't miss out on this essential resource. Get your copy of Medical Revenue Cycle Management: One Book To Make You Genius today and take your first step towards mastering this dynamic field!




Principles of Healthcare Reimbursement


Book Description

Principles of Healthcare Reimbursement provides a comprehensive overview of the complex world of healthcare reimbursement. In today's healthcare landscape, understanding the intricacies of reimbursement systems is essential for healthcare providers, administrators, and professionals working in the healthcare industry. This book delves into the principles, policies, and practices involved in healthcare reimbursement, equipping readers with the knowledge they need to navigate this critical aspect of healthcare delivery. With a focus on the United States healthcare system, this book explores the various types of reimbursement systems, including public programs such as Medicare and Medicaid, as well as private insurance systems. It covers the role of insurance in reimbursement, the coding and billing process, and the impact of managed care on reimbursement models. Additionally, it discusses emerging trends in reimbursement, such as value-based models and the reimbursement challenges faced in rural healthcare settings.




Principles of Healthcare Reimbursement


Book Description

A healthcare reimbursement plan is an advantage where managers repay their workers for clinical costs. This contrasts from customary gathering wellbeing plan inclusion in light of the fact that the business offers an advantage leniency accessible as opposed to picking and overseeing a gathering health care coverage strategy from a transporter.




Hospital Reimbursement


Book Description

Due to the countless variables that affect revenue and cost, the hospital reimbursement process is by far the most complex of any industry. Requiring only a basic financial background and a working knowledge of accounting, Hospital Reimbursement: Concepts and Principles supplies a clear understanding of the concepts and principles that drive the re