Cost-based, charge-based, and contractual payment systems

Content: Introduction Preliminary Comments Review of Healthcare Payment Systems      Claims Filing and Payment      Deductibles and Copayments      Fee Schedule Payment Systems      Prospective Payment Systems      Cost-Based Payment Systems      Charge-Based Payment Systems      Capitation Payment Systems      Contractual Payment Systems Healthcare Provider Concepts      Physicians      Nonphysician Practitioners and Providers      Clinics      Hospitals Hospitals and Integrated Delivery Systems      Special Provider Organizations           DME Suppliers           Skilled Nursing Facilities           Home Health Agencies           Independent Diagnostic Testing Facilities           Comprehensive Outpatient Rehabilitation Facilities           Clinical Laboratories           Ambulatory Surgical Centers Claim Adjudication and Payment Processing Summary and Conclusion     Healthcare Provider Costs and Cost-Based Payment Systems Introduction Costs and Cost Accounting Medicare Cost Report Cost-Based Payment: Key Features Critical Access Hospitals Rural Health Clinics and Federally Qualified Health Centers Summary and Conclusion        Healthcare Provider Charges and Charge-Based Payment Systems Introduction Charge-Based Payment: Key Features      Charge Structures for Healthcare Providers      Healthcare Pricing Strategies Chargemasters for Hospitals and Integrated Delivery Systems      Charge CompressionMedicare Charging Rule      Healthcare Provider Charges and Public Scrutiny Summary and Conclusion        Contractual Payment Systems Introduction HIPAA Transaction Standards Managed Care Organizations Terminology and Contract Features      Definitions      Reimbursement and Payment Terms      Provision of Services      Payer and Payee Obligations      Payment Mechanisms      Credentialing Processes      Medical Necessity and Coverage Issues      Administrative Proceedings      Access to Records and Audits Negotiating and Analyzing MCO Contracts      Precontract Data Gathering      Contract and Relationship Analysis      Financial Analysis and Modeling      Operational Monitoring      Renewal and Termination Medicare Advantage Plans Summary and Conclusion        Capitated Payment Systems Introduction Capitation: Key Features Risk Management through Insurance Models for Capitation Summary and Conclusion        Claim Adjudication and Compliance Introduction Statutory versus Contractual Compliance Audits and Reviews      Types of Audits      Audit Process      Extrapolation Process      Audit Reports      Audit Dependence on Payment Mechanism      Claim Modification Issues A Systematic Approach to Compliance Secondary-Payer Issues Healthcare Provider Credentialing Summary and Conclusion        Summary, Conclusion, and the Future Healthcare Payment Systems: A Historical Perspective Extreme Variability in Payment Systems Compliance Issues Payment Systems: The Future Endnote    List of Acronyms        Appendix: Synopsis of the Medicare Program's Payment Systems Appendix: Case Study List        Index