Cost-based, charge-based, and contractual payment systems / Duane C. Abbey.

Format:

Book

Author/Creator:

Abbey, Duane C., author.

Series:

Healthcare payment systems.

Healthcare Payment Systems

Language:

English

Subjects (All):

Medical fees--United States.

Medical fees.

Health insurance claims--United States.

Health insurance claims.

Physical Description:

1 online resource (227 pages).

Edition:

1st edition

Place of Publication:

Boca Raton, Florida ; London, [England] ; New York, [New York] : CRC Press, 2013.

System Details:

text file

Summary:

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.

Contents:

Front Cover

Dedication

Contents

Preface

About the Author

1. Introduction

2. Healthcare Provider Costs and Cost-Based Payment Systems

3. Healthcare Provider Charges and Charge-Based Payment Systems

4. Contractual Payment Systems

5. Capitated Payment Systems

6. Claim Adjudication and Compliance

7. Summary, Conclusion, and the Future

List of Acronyms

Appendix: Synopsis of the Medicare Program's Payment Systems

Appendix: Case Study List.

Notes:

Includes index.

Description based on print version record.

ISBN:

9781040084045

1040084044

9780429251498

0429251491

9781138431829

1138431826

9781439872994

1439872996

9781439873007

1439873003

OCLC:

1080588734