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.

"Up-to-date information on proper medical billing reimbursement and the codes, third party payers, and laws that affect it"--Provided by publisher.

The most comprehensive resource for hospital inpatient coding and reimbursement! Provides educators, students, and healthcare practitioners with the most authoritative guidance available for managing inpatient coding and reimbursement issues. This must-have resource was developed to give you easier access to the most up-to-date information you need for inpatient coding and reimbursement. You'll save time and make more effective decisions with this one-of-a-kind resource.Covers reimbursement methodologies for hospital inpatient services, the structure and organization of hte Medicare Inpatient Acute Care Prospective Payment System, the relationship between coding and DRG assignment, and data quality and coding compliance processes related to coding and reimbursement for inpatient services.

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.

Two CD-ROM discs in pocket.