Download Cost-based, charge-based, and contractual payment systems by Duane C. Abbey PDF

By Duane C. Abbey

The fourth ebook within the Healthcare money System sequence, Cost-Based, Charge-Based, and Contractual check Systems compares cost-based structures, charge-based check ways, and contractually-based money methods with fee-schedule check platforms and potential cost structures. offering readers with a transparent realizing of vital history fabric at the types of healthcare companies, it covers the fundamentals of cost-based, charge-based, and contractual check platforms.

The e-book illustrates crucial ideas with a chain of straightforward case studies―making it perfect for an individual attracted to studying extra concerning the particular structures and tactics used for check in healthcare companies. It discusses Medicare cost-based cost platforms, Medicare money techniques, and comprises an appendix that outlines some of the Medicare cost structures. Demystifying contractual language, it outlines controlled care contracts and likewise:

  • Delves into the intricacies concerned with adjudication of claims
  • Considers capitated check systems
  • Addresses healthcare bills and cost-based repayment systems
  • Examines charge-based and contractual money systems
  • Describes the place healthcare money structures are headed within the future

Since compliance is inherent through the technique of delivering providers, filling claims, and receiving check, the e-book examines the variety of compliance matters, together with statutory, contractual, and overpayment matters. utilizing a number of examples to demonstrate the strategies used for capitated agreement preparations, the publication comprises insurance of declare adjustment, controlled care contracts, and a few of the combos of money platforms utilized by third-party directors.

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Additional info for Cost-based, charge-based, and contractual payment systems

Sample text

There is a per diem payment rate for medical cases and another higher per diem payment rate for surgical cases. 20 for more information on EMTALA. † See the Method II billing and payment process for CAHs discussed in Chapter 2. 12, there are typically a number of other questions that arise. In this case study, the insurance company is going to be concerned about the medical necessity of the patient being in the hospital for a given period of time. Apex will probably be concerned about extensive surgeries for which there may not be a correspondingly long in-hospital recovery period.

The big question would revolve around what costs Dr. Brown incurs in providing healthcare services. This would involve services at the clinic as well as at the hospital or at other locations, such as a skilled nursing facility. Also, would these costs be at a general or gross level, or would they be at a visit or specific procedure level? Some thought would also involve distinguishing operating costs from capital costs. As you should discern from Dr. Brown’s situation, costs at this clinic are probably not really known.

At this time, physicians and practitioners are generally paid separately from any sort of global facilities payment. Nonphysician Practitioners and Providers For the very large number of healthcare providers who do not hold doctorates, the general term nonphysician provider is used. This category includes nurses, medical assistants, radiology technicians, and physical therapists, and a long list can be developed. Even within the classification of a nurse, there can be many different types of nurses and associated specialty certifications.

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