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.
Contents
Fundamentals of Accounting
Introduction
History and Framework
Accounting Services
Auditing
Financial Concepts and Terminology
Additional Financial Terms
Financial Statements
Budgeting
Cost Accounting
Inventory Management
Sensitivity Analysis
Relative Sales Value
Other Ratios
Conclusi>References
Types of Hospitals/Conceptual Framework
History and Introduction
Not-for-Profit Hospitals
Unrelated Business Income
For-Profit Hospitals
Government-Owned Hospitals
Board of Directors
Senior Management
Certificate of Need
Hospital Consolidation
Conclusion
References
Hospital Revenue Cycle
Introduction
Patient Access
Billing
Revenue Sources (Payers)
Payer Mix
Medical Records
Case Management/Utilization Review
Cash Collections
Hospital Contracting
Fraud/Abuse
Recovery Audit Contractors
Form 990
Conclusion
References
Hospital Services
Introduction
Inpatient/Outpatient
Facility/Professional Fee
Emergency Room
Surgery
Cardiology
Women’s Services/Birthing Unit
Neonatal Intensive Care Unit
Oncology
Radiology
Pharmacy
Laboratory
Observation Days
