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Download Healthcare Payment Systems: An Introduction by Duane C. Abbey PDF

By Duane C. Abbey

The ability degrees of economic staff can differ up to these of scientific body of workers, and the influence that those employees have at the viability, not to mention profitability and effective operating, of any medical institution, scientific perform or facility is sort of profound. the typical trust now's that the multitude of fee structures that each clinical practitioner needs to entry, with their varied approaches and hundreds of thousands if no longer millions of scientific codes, are scarcely workable. notwithstanding, with the ideal wisdom and the perfect process, you could flip a method that controls you into one who you control.

Healthcare cost platforms: An advent presents a whole advent to healthcare cost platforms. Written via Duane Abbey, one of many nation’s best specialists and such a lot sought out experts in money platforms, this quantity makes the enormous activity of clinical repayment approachable and achievable. overlaying all of the basics and terminology had to comprehend this self-discipline, and the perception and methods had to grasp it, Dr. Abbey —

  • Provides an in depth realizing of the diversities between healthcare money systems
  • Shows you the simplest how one can categorize particular third-party payer standards
  • Explains what you want to find out about Medicare’s use of alternative check systems
  • Gives you the knowledge had to negotiate larger contractual preparations

This self-contained advisor is greater than a reference. It presents an outline and dialogue of subject matters that one needs to comprehend to optimize utilization of varied structures. eventually, it is going to assist you start to advance the forged middle of talents and information had to with a bit of luck technique cost platforms as instruments to take advantage of instead of risks to prevent -- instruments that might bring about enhanced profit cycles and better degrees of profitability.

This publication is the 1st in Dr. Abbey’s Healthcare cost approach Series from productiveness Press. search for destiny books within the sequence masking numerous service-specific money platforms for physicians, hospitals, and really good programs.

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Extra info for Healthcare Payment Systems: An Introduction

Sample text

Capitation is a paradigm shift from the FFS concept. With capitated payment arrangements, the payer pays a fixed amount in advance and the healthcare provider agrees to provide any and all necessary services. Such arrangements are typically on a per-member-per-month arrangement. This really is a radical change because the location of risk has changed from the payer to the provider. If the provider is receiving a fixed amount and the service levels invoke costs that are above the capitated payment, then the provider will lose money.

Payment System Interfaces In Chapter 4 we will look at how some of these payment systems interface with each other. A given service might be paid under several different payment systems depending upon circumstances. Let us consider a simple example with the Medicare program. 14—Coronary Stent Placement An elderly patient had a diagnostic heart catheterization at a smaller hospital 2 weeks ago. The patient is presenting for percutaneous stent placement. The physician has decided to admit the patient to the hospital as an inpatient.

See the RAC (Recovery Audit Contractor) program that is used by Medicare to identify overpayments (and theoretically underpayments). Many of the issues audited under this recovery program involve medical necessity determinations. 34 ◾ Healthcare Payment Systems: An Introduction Weight Determination Each APC or APG category has an associated relative weight. The relative weight is designed to reflect the resource intensity consumed by the provision of the service or services that are in the given APC or APG category.

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