Principles Of Healthcare Reimbursement And Revenue Cycle Management Eighth Edition

Health Care Finance and the Mechanics of Insurance and Reimbursement 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, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Updated throughout the Third Edition offers expanded material on financial statements; new and expanded Skilled Nursing Facility examples; and enhanced sections on PDPM, Practice Management for Primary Care and other Specialties, Clearinghouse Processes, Predictive Modeling (data mining), and more.

Medical Revenue Cycle Management: One Book To Make You Genius by VIRUTI SHIVAN Are you a student aspiring to excel in the complex world of medical revenue cycle management? Look no further! This comprehensive guide is tailor-made to equip you with the knowledge and skills necessary to navigate the intricacies of this vital healthcare discipline. Medical Revenue Cycle Management: One Book To Make You Genius is a must-have resource that covers every aspect of the revenue cycle process, from patient registration to claim reimbursement. Written with students in mind, this book offers a comprehensive overview of the subject, providing a solid foundation for your future career. Inside this guide, you will find: 1. Introduction to Medical Revenue Cycle Management: Gain a clear understanding of the revenue cycle and its significance in healthcare organizations. Explore the various roles and responsibilities involved in revenue cycle management. 2. Patient Access and Registration: Learn the fundamentals of patient registration, insurance verification, and the importance of accurate patient data collection. Understand the impact of accurate information on revenue optimization. 3. Health Insurance and Payer Systems: Explore the intricacies of health insurance, different types of payers, and their impact on revenue cycle management. Gain insights into payer contracts, claim submission, and electronic data interchange (EDI). 4. Coding and Documentation: Discover the importance of accurate medical coding and its impact on reimbursement. Master the principles of coding, documentation guidelines, and coding systems such as ICD-10-CM and CPT. 5. Claims Management and Denial Resolution: Delve into the world of claims management, including claim submission, tracking, and denial resolution. Learn effective strategies to minimize claim denials and maximize revenue recovery. 6. Billing and Reimbursement: Understand the intricacies of billing processes, including charge capture, pricing, and electronic billing systems. Explore reimbursement methodologies, such as fee-for-service and value-based reimbursement. 7. Compliance and Regulatory Considerations: Stay up to date with the ever-evolving healthcare regulations and compliance requirements. Learn about HIPAA, fraud and abuse laws, and the importance of ethical billing practices. 8. Key Performance Indicators and Revenue Cycle Analytics: Gain insights into tracking and measuring revenue cycle performance through key performance indicators (KPIs) and analytics. Learn to identify areas for improvement and optimize revenue generation. With its student-friendly approach, practical examples, and case studies, this guide ensures that you not only grasp the theoretical concepts but also develop the critical thinking and problem-solving skills necessary for success in this field. Whether you are a healthcare administration student, aspiring medical coder, or revenue cycle professional, this comprehensive guide will serve as your go-to reference, providing you with a solid foundation in medical revenue cycle management. Unlock your potential and embark on a successful career in this crucial area of healthcare administration with confidence! Don't miss out on this essential resource. Get your copy of Medical Revenue Cycle Management: One Book To Make You Genius today and take your first step towards mastering this dynamic field!

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.

Management Principles for Health Professionals is a practical guide for new or future practicing healthcare managers. The customary activities of the manager—planning, organizing, decision making, staffing, motivating, and budgeting—are succinctly defined, explained, and presented with detailed examples drawn from a variety of health care settings. Students will learn proven management concepts, techniques, models, and tools for managing individuals or teams with skill and ease. The Eighth Edition continues to present foundational principles of management in the context of contemporary health care. With timely coverage of such topics as medical cost sharing; use of robots; ER by appointment; increased use of observation units; renewed use of flextime staffing and scheduling; use of social media on the job, and more, this thoroughly updated text addresses the latest trends and issues that today's health care manager is likely to encounter.