Crossing the Quality Chasm


Book Description

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.







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




Health Care Finance and the Mechanics of Insurance and Reimbursement


Book Description

Health Care Finance and the Mechanics of Insurance and Reimbursement 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, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Updated throughout the Third Edition offers expanded material on financial statements; new and expanded Skilled Nursing Facility examples; and enhanced sections on PDPM, Practice Management for Primary Care and other Specialties, Clearinghouse Processes, Predictive Modeling (data mining), and more.




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.







The New Health Care for Profit


Book Description

An introduction to the new health care for profit. Legal differences between investor-owned and nonprofit health care institutions. Wall Street and the for-profit hospital management companies. When investor-owned corporations buy hospitals: some issues and concerns. Physician involvement in hospital decision making. Economic incentives and clinical decisions. Ethical dilemmas of for-profit enterprise in health care. Secondary income from recommended treatment: should fiduciary principles constrain physician behavior?