Mastering the Reimbursement Process


Book Description

Rev. ed. of: Mastering the reimbursement process / Curtis J. Udell, Susan E. Garrison, Deane R. Ferguson. 1996.




Mastering the Reimbursement Process


Book Description




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 revenue cycle within a hospital setting. The book explains the technical aspects of reimbursement in language that is easy to comprehend. It illustrates the complexities of the hospital revenue cycle and explains the Medicare and Medicaid financial models in detail. The text also addresses the Medicaid reimbursement methodology, the formulation of the Medicare blend rate, the computation of both DSH and IME, as well as other third-party payers. It also: Covers the full range of services and procedures for which a hospital can receive reimbursement Explains the difference between a for-profit and not-for-profit hospital Contains chapters devoted to Statements of Operations (Income Statement) and Statements of Financial Position (Balance Sheet) Examines governmental cost reporting—including Worksheets A, A-6, A-8, A-8-2, B-1, B Part 1, C Part 1, D-3, D-5, and E Part A Supplying readers with a foundation in coding principles, the text also includes a model for calculating the financial impact of variations in patient length of stay. It discusses the DRG and APC reimbursement models and details the computation of an outlier payment. In addition, it walks the reader step-by-step through the creation of a mock Medicare cost report for a sample hospital.




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.




Denials Management & Appeals Reference Guide - First Edition


Book Description

Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more!




Master Medicare Guide 2015


Book Description

The 2015 Master Medicare Guide is a one-volume desk reference packed with timely and useful information for providers, attorneys, accountants, and consultants who need to stay on top of one of the most complex programs maintained by the federal government.




The Master Guide to Controllers' Best Practices


Book Description

The essential guide for today’s savvy controllers Today’s controllers are in leadership roles that put them in the unique position to see across all aspects of the operations they support. The Master Guide to Controllers’ Best Practices, Second Edition has been revised and updated to provide controllers with the information they need to successfully monitor their organizations’ internal control environments and offer direction and consultation on internal control issues. In addition, the authors include guidance to help controllers carryout their responsibilities to ensure that all financial accounts are reviewed for reasonableness and are reconciled to supporting transactions, as well as performing asset verification. Comprehensive in scope the book contains the best practices for controllers and: Reveals how to set the right tone within an organization and foster an ethical climate Includes information on risk management, internal controls, and fraud prevention Highlights the IT security controls with the key components of successful governance Examines the crucial role of the controller in corporate compliance and much more The Master Guide to Controllers’ Best Practices should be on the bookshelf of every controller who wants to ensure the well-being of their organization. In addition to their traditional financial role, today’s controllers (no matter how large or small their organization) are increasingly occupying top leadership positions. The revised and updated Second Edition of The Master Guide to Controllers’ Best Practices provides an essential resource for becoming better skilled in such areas as strategic planning, budgeting, risk management, and business intelligence. Drawing on the most recent research on the topic, informative case studies, and tips from finance professionals, the book highlights the most important challenges controllers will face. Written for both new and seasoned controllers, the Guide offers a wide range of effective tools that can be used to improve the skills of strategic planning, budgeting, forecasting, and risk management. The book also contains a resource for selecting the right employees who have the technical knowledge, analytical expertise, and strong people skills that will support the controller’s role within an organization. To advance overall corporate performance, the authors reveal how to successfully align strategy, risk management, and performance management. In addition, the Guide explains what it takes to stay ahead of emerging issues such as healthcare regulations, revenue recognition, globalization, and workforce mobility. As controllers adapt to their new leadership roles and assume more complex responsibilities, The Master Guide to Controllers’ Best Practices offers an authoritative guide to the tools, practices, and ideas controllers need to excel in their profession.




The Physician Billing Process


Book Description

This third edition of the MGMA bestseller on physician billing process and revenue cycle management is a completely revised, comprehensive manual. Delivering proven solutions to optimize your revenue cycle, this professional fee billing primer is business-critical whether you're new to managing the revenue cycle or a seasoned professional.




Mastering Medical Coding - E-Book


Book Description

Expansion of ICD-9-CM information. - Sample patient charts include explanatory notes. - A simulated medical practice (identified as Godfrey Regional) lets you study in a real-world scenario. - Key Terms lists highlight the most important vocabulary and content. - More exercises!




Medical Coding


Book Description

In clear and straightforward language, Medical Coding: What It Is and How It Works, Second Edition provides an overview of the evolution of medical coding and all the various coding systems, how they relate, and how they function. Reasoning and consequences of the delayed ICD-10 implementation are explained along with a sound overview of the ICD-10-CM and PCS classification systems. For those contemplating a career in the coding field, this book is ideal as a basic orientation. Other individuals in healthcare management and administration will also benefit from a basic understanding of how coding works. Unlike other publications that focus only on coding, this book integrates coding guidelines and principles into the billing and reimbursement process, giving the student a more practical foundation in the rationale for correct coding. Healthcare fraud and abuse is addressed as well, to assure that readers understand ethical concerns inherent in coding for reimbursement. Instructor Resources: Instructor's Manual, PowerPoint slides, Test Bank