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

By Duane C. Abbey

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

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

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

Since compliance is inherent through the strategy of delivering prone, filling claims, and receiving money, the publication examines the variety of compliance matters, together with statutory, contractual, and overpayment concerns. utilizing a variety of examples to demonstrate the techniques used for capitated agreement preparations, the booklet contains assurance of declare adjustment, controlled care contracts, and a few of the combos of fee structures utilized by third-party directors.

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As a result, the hospital is reorganizing one floor of the hospital to accommodate a hospital within a hospital. The new hospital will be an LTCH actually inside the short-term acute care hospital. 13 will bear fruit is an interesting question. However, this case study does illustrate the organizational complexity that can evolve in lieu of different kinds of payment mechanisms for hospitals. Hospitals and Integrated Delivery Systems Over the past several decades, there has been significant movement to consolidate various types of healthcare providers into seamless delivery systems.

Even if not organizationally connected, why would an ASC be physically located next to a hospital? Keep in mind that the ASC closes at 5:00 pm. What happens if there is a patient at the ASC who is not fully recovered? If you look around your community, assuming that you are someplace close to a metropolitan area, you may start recognizing ASCs that may be highly specialized. 20: Cataract Surgery ASC Anywhere, USA, has the distinction of having a specialized ASC in the community. While this is not a metropolitan area, there is a sizable number of retirees on Medicare.

While our focus is on individuals and organizations that actually file claims and receive reimbursement, there are other healthcare providers that are not directly reimbursed for services. These providers are typically employees of healthcare organizations. For instance, nurses, medical assistants, technicians, phlebotomists, pharmacists, and many others are involved in providing healthcare, but it is their employing organization that is reimbursed. We briefly discuss the general classes of healthcare providers, starting with individuals such as physicians and various practitioners.

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