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Cost-Based, Charge-Based, and Contractual Payment Systems (Paperback, New)
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Cost-Based, Charge-Based, and Contractual Payment Systems (Paperback, New)
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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.
General
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