Rev. ed. of: Mastering the reimbursement process / Curtis J. Udell, Susan E. Garrison, Deane R. Ferguson. 1996.

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.

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.

Recoup lost time and revenue with denials management and appeals know-how. Claim denials can sink a profit margin. And given the cost of appeals, roughly $118 per claim, not all denials can be reworked. A practice submitting 50 claims a day at an average reimbursement rate of $200 per claim should bring in $10,000 in daily revenue. But if 10% of those claims are denied, and the practice can only appeal one, they lose $800 per day—upwards of $200K annually. Your medical claims are the lifeblood of operations. Don’t compromise your financial health. Learn how to preempt denials with the Denials Management & Appeals Reference Guide. This vital resource will equip you to get ahead of payers by simplifying the leading causes of denials and showing you how to address insufficient documentation, failing to establish medical necessity, coding and billing errors, coverage stipulations, and untimely filing. Rely on AAPC to walk you through the appeal process. We’ll help you establish protocols to avoid an appeals backlog and teach you how to identify and prioritize denials likely to win an appeal. What’s more, you’ll learn when a claim can be “reopened” to fix a problem. Collect the revenue your practice deserves with effective denials and appeals solutions: Know how to analyze your denials Defeat documentation and compliance issues for successful claims success Utilize payer policy for coverage clues Lock in revenue with face-to-face reimbursement guidance Refine efforts to avoid E/M claim denials Ace ICD-10 coding for optimum reimbursement Put an end to modifier confusion Stave off denials with CCI edits advice Navigate the appeals process like a pro And much more!

The 2015 Master Medicare Guide is a one-volume desk reference packed with timely and useful information for providers, attorneys, accountants, and consultants who need to stay on top of one of the most complex programs maintained by the federal government.

The essential guide for today’s savvy controllers Today’s controllers are in leadership roles that put them in the unique position to see across all aspects of the operations they support. The Master Guide to Controllers’ Best Practices, Second Edition has been revised and updated to provide controllers with the information they need to successfully monitor their organizations’ internal control environments and offer direction and consultation on internal control issues. In addition, the authors include guidance to help controllers carryout their responsibilities to ensure that all financial accounts are reviewed for reasonableness and are reconciled to supporting transactions, as well as performing asset verification. Comprehensive in scope the book contains the best practices for controllers and: Reveals how to set the right tone within an organization and foster an ethical climate Includes information on risk management, internal controls, and fraud prevention Highlights the IT security controls with the key components of successful governance Examines the crucial role of the controller in corporate compliance and much more The Master Guide to Controllers’ Best Practices should be on the bookshelf of every controller who wants to ensure the well-being of their organization. In addition to their traditional financial role, today’s controllers (no matter how large or small their organization) are increasingly occupying top leadership positions. The revised and updated Second Edition of The Master Guide to Controllers’ Best Practices provides an essential resource for becoming better skilled in such areas as strategic planning, budgeting, risk management, and business intelligence. Drawing on the most recent research on the topic, informative case studies, and tips from finance professionals, the book highlights the most important challenges controllers will face. Written for both new and seasoned controllers, the Guide offers a wide range of effective tools that can be used to improve the skills of strategic planning, budgeting, forecasting, and risk management. The book also contains a resource for selecting the right employees who have the technical knowledge, analytical expertise, and strong people skills that will support the controller’s role within an organization. To advance overall corporate performance, the authors reveal how to successfully align strategy, risk management, and performance management. In addition, the Guide explains what it takes to stay ahead of emerging issues such as healthcare regulations, revenue recognition, globalization, and workforce mobility. As controllers adapt to their new leadership roles and assume more complex responsibilities, The Master Guide to Controllers’ Best Practices offers an authoritative guide to the tools, practices, and ideas controllers need to excel in their profession.

Expansion of ICD-9-CM information. - Sample patient charts include explanatory notes. - A simulated medical practice (identified as Godfrey Regional) lets you study in a real-world scenario. - Key Terms lists highlight the most important vocabulary and content. - More exercises!

The 2015 Master Medicare Guide is packed with timely and useful information to help you stay on top of one of the most complex programs administered by the federal government. The 2015 Edition includes: Over 500 explanation summaries for all aspects of the Medicare program coverage, eligibility, reimbursement, fraud and abuse, and administration Highlights of the Protecting Access to Medicare Act of 2014 (P.L. 113-93) and the Improving Medicare Post-Acute Care Transformation Act of 2014 (P.L. 113-185)""; the most recent physician fee schedule reimbursement fix; A focus on the continuing implementation of the Affordable Care Act as it relates to Medicare, including accountable care organizations and a tighter link between the quality of health care and Medicare reimbursement All discussions include cross-references to relevant laws, regulations, CMS manual sections, administrative and judicial decisions, and more!

Executing Data Quality Projects, Second Edition presents a structured yet flexible approach for creating, improving, sustaining and managing the quality of data and information within any organization. Studies show that data quality problems are costing businesses billions of dollars each year, with poor data linked to waste and inefficiency, damaged credibility among customers and suppliers, and an organizational inability to make sound decisions. Help is here! This book describes a proven Ten Step approach that combines a conceptual framework for understanding information quality with techniques, tools, and instructions for practically putting the approach to work – with the end result of high-quality trusted data and information, so critical to today's data-dependent organizations. The Ten Steps approach applies to all types of data and all types of organizations – for-profit in any industry, non-profit, government, education, healthcare, science, research, and medicine. This book includes numerous templates, detailed examples, and practical advice for executing every step. At the same time, readers are advised on how to select relevant steps and apply them in different ways to best address the many situations they will face. The layout allows for quick reference with an easy-to-use format highlighting key concepts and definitions, important checkpoints, communication activities, best practices, and warnings. The experience of actual clients and users of the Ten Steps provide real examples of outputs for the steps plus highlighted, sidebar case studies called Ten Steps in Action. This book uses projects as the vehicle for data quality work and the word broadly to include: 1) focused data quality improvement projects, such as improving data used in supply chain management, 2) data quality activities in other projects such as building new applications and migrating data from legacy systems, integrating data because of mergers and acquisitions, or untangling data due to organizational breakups, and 3) ad hoc use of data quality steps, techniques, or activities in the course of daily work. The Ten Steps approach can also be used to enrich an organization's standard SDLC (whether sequential or Agile) and it complements general improvement methodologies such as six sigma or lean. No two data quality projects are the same but the flexible nature of the Ten Steps means the methodology can be applied to all. The new Second Edition highlights topics such as artificial intelligence and machine learning, Internet of Things, security and privacy, analytics, legal and regulatory requirements, data science, big data, data lakes, and cloud computing, among others, to show their dependence on data and information and why data quality is more relevant and critical now than ever before. - Includes concrete instructions, numerous templates, and practical advice for executing every step of The Ten Steps approach - Contains real examples from around the world, gleaned from the author's consulting practice and from those who implemented based on her training courses and the earlier edition of the book - Allows for quick reference with an easy-to-use format highlighting key concepts and definitions, important checkpoints, communication activities, and best practices - A companion Web site includes links to numerous data quality resources, including many of the templates featured in the text, quick summaries of key ideas from the Ten Steps methodology, and other tools and information that are available online