Health Care Finance And The Mechanics Of Insurance And Reimbursement

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.

Navigate 2 Advantage Access For Health Care Finance And The Mechanics Of Insurance And Reimbursement Is A Digital-Only Access Code That Unlocks A Comprehensive And Interactive Ebook, Student Practice Activities And Assessments, A Full Suite Of Instructor Resources, And Learning Analytics Reporting System. Navigate 2 Is Nearly Here. In The Meantime, We Invite You To Redeem Your Access Code And Join Our Lounge. Once Your Navigate 2 Advantage Access Is Live, We Will Notify You Via Email. This Navigate 2 Digital-Only Package For Health Care Finance And The Mechanics Of Insurance And Reimbursement Offers The Following: •Learn: A Complete Ebook With Interactive Tools •Practice: A Virtual Study Center With Robust Practice Activities And Flashcards •Assess: A Homework And Testing Assessment Center With Prepopulated Quizzes And Examinations •Analyze: Dashboards With Learner And Educator Views That Reports Actionable Data Learn More About Navigate 2 At Http: //Www.Jblnavigate.Com/2

Includes case studies for assignments and classroom discussion Covers NP practice financial management Comprehensive instructor's manual available including presentation slides, chapter guides, and grading rubrics This textbook is designed for students preparing as advanced practice clinicians, including APRNs, DNPs, DPTs, DOTs, and physician assistants. The book covers both health policy issues and practice financial management issues. It is organized into seven sections in two parts. The first part is focused on macro issues in healthcare finance, and the second part is focused on healthcare financing management in professional practice. This approach provides the context necessary for the clinician to understand how to manage reimbursement requirements and preferred provider contracting as health care financial policy drives these payment and contracting strategies. Each section features a case study to facilitate classroom discussion on key points. This book is suitable for healthcare finance courses in the curriculum for MSN and DNP programs and also for schools of social work, medicine, occupational, and physical therapy.

As a growing number of healthcare organizations implement project management principles to improve cost and service efficiencies, they are in desperate need of resources that illustrate the project management needs of today's healthcare professional. Project Management for Healthcare fills this need. Using easy-to-follow language, it expl

Extremely practical and packed with current examples, Introduction to Health Care: Finance and Accounting delivers a comprehensive overview of the business side of healthcare. This entry-level healthcare finance book offers detailed discussions of cost reimbursement programs, economic factors driving the rising costs of medical services, and healthcare reform through the Patient Protection and Affordable Care Act of 2010. It explains the basics of healthcare accounting and finance, from accounting fundamentals, operating the cash drawer and bank reconciliation through the more complex issues of cash management, budgeting and variance analysis, and revenue cycle management. Important Notice: Media content referenced within the product description or the product text may not be available in the ebook version.

Risk Management Handbook for Health Care Organizations, Student Edition This comprehensive textbook provides a complete introduction to risk management in health care. Risk Management Handbook, Student Edition, covers general risk management techniques; standards of health care risk management administration; federal, state and local laws; and methods for integrating patient safety and enterprise risk management into a comprehensive risk management program. The Student Edition is applicable to all health care settings including acute care hospital to hospice, and long term care. Written for students and those new to the topic, each chapter highlights key points and learning objectives, lists key terms, and offers questions for discussion. An instructor's supplement with cases and other material is also available. American Society for Healthcare Risk Management (ASHRM) is a personal membership group of the American Hospital Association with more than 5,000 members representing health care, insurance, law, and other related professions. ASHRM promotes effective and innovative risk management strategies and professional leadership through education, recognition, advocacy, publications, networking, and interactions with leading health care organizations and government agencies. ASHRM initiatives focus on developing and implementing safe and effective patient care practices, preserving financial resources, and maintaining safe working environments.

A collection of peer-reviewed articles and contributions to books, this overview of the finance of health insurance concentrates on developing countries. The material covers various financing strategies and explains how each can--or cannot--help improve the transition toward universal coverage. The model plans shown here are particularly useful for policy-makers and technical advisers who have to decide upon health financing policies--or are engaged in a debate about them--and the sample forms can be adjusted to the particular economic and political context of the developing countries involved. In addition, there are reminders that this process varies: in some countries, universal coverage may take time and require a step-by-step approach. In other developing countries, a swift transition to universal coverage may be quite feasible.

Accounting Fundamentals for Health Care Management is ideal for an introductory course in financial accounting in both undergraduate and graduate programs. With a focus on basic accounting in health care management, this essential book contains the vocabulary of and an introduction to the tools and concepts employed by finance officers. Students will learn how to assess financial information, ask the appropriate questions, and understand the jargon-laden answers.

This unique book provides a solid understanding of the basics of modeling and assists health care professionals in grasping its uses in creating and implementing informed health care policy. Modelling in Health Care Finance offers the quantitative and analytic tools needed for sound resource allocation and financial governance of health systems. It creates synergies and bridges gaps between quantitative health economics, health financing, and actuarial science while presenting methods for improving the efficiency and lowering the costs of current health systems. A valuable guidebook for health system and health insurance managers alike, this volume traces the foundations of modeling and explains how these very useful and available tools can aid in the design of effective health care policy. In straightforward, non-technical language, the book demystifies the modeling process and provides step-by-step guidance through model construction. From forming health policy goals, identifying options, and analyzing results, to actual implementation, the book demonstrates how managers and policy-makers can make use of models. Written by a team of health care policy experts from the ILO and other contributors, the book also includes a substantial glossary of terms, a section of accessible reference materials, and issue briefs that cover concepts of health economics, mathematics of private health insurance, and basic econometric techniques.

Health Insurance and Managed Care: What They Are and How They Work is a concise introduction to the workings of health insurance and managed care within the American health care system. Written in clear and accessible language, this text offers an historical overview of managed care before walking the reader through the organizational structures, concepts, and practices of the health insurance and managed care industry. The Fifth Edition is a thorough update that addresses the current status of The Patient Protection and Affordable Care Act (ACA), including political pressures that have been partially successful in implementing changes. This new edition also explores the changes in provider payment models and medical management methodologies that can affect managed care plans and health insurer.

The objectives of this study are to describe experiences in price setting and how pricing has been used to attain better coverage, quality, financial protection, and health outcomes. It builds on newly commissioned case studies and lessons learned in calculating prices, negotiating with providers, and monitoring changes. Recognising that no single model is applicable to all settings, the study aimed to generate best practices and identify areas for future research, particularly in low- and middle-income settings. The report and the case studies were jointly developed by the OECD and the WHO Centre for Health Development in Kobe (Japan).

The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.

Thoroughly revised, this third edition of Financial Management of Health Care Organizations offers an introduction to the most-used tools and techniques of health care financial management. Comprehensive in scope, the book covers a broad range of topics that include an overview of the health care system and evolving reimbursement methodologies; health care accounting and financial statements; managing cash, billings, and collections; the time value of money and analyzing and financing major capital investments; determining cost and using cost information in decision-making; budgeting and performance measurement; and pricing. In addition, this new edition includes information on new laws and regulations that affect health care financial reporting and performance, revenue cycle management expansion of health care services into new arenas, benchmarking, interest rate swaps, bond ratings, auditing, and internal control. This important resource also contains information on the 2007 Healthcare Audit Guide of the American Institute of Certified Public Accountants (AICPA). Written to be accessible, the book avoids complicated formulas. Chapter appendices offer advanced, in-depth information on the subject matter. Each chapter provides a detailed outline, a summary, and key terms, and includes problems in the context of real-world situations and events that clearly illustrate the concepts presented. Problem sets that end each chapter have been updated and expanded to support more in-depth learning of the chapters’ concepts. An Instructor’s Manual, available online, contains PowerPoint and Excel files.

Career Opportunities in Healthcare Management is a concise, reader-friendly, introductory healthcare management book that covers a wide variety of career opportunities in a broad range of direct healthcare settings--such as hospitals, physician practices, nursing homes, and clinics--and non-direct health care settings, such as associations, managed care and health insurance companies, consulting firms, and medical supplier firms. Filled with first person accounts from health care managers working in the field, these profiles will engage the reader’s imagination, inform them of key issues associated with these important roles, as well as what makes these health care managers happy and eager to go to work in the morning. Beginning with an individualized 'Health Care Management Talent Quotient Quiz' and ending with a guide to finding a job in healthcare management, this hands on student-friendly and teacher-friendly text is the perfect resource for students of healthcare management, nursing, allied health, business administration, pharmacy, occupational therapy, public administration, and public health. Features: • The experienced authors use an active voice to grab the reader’s attention. • An individualized Health Care Management Talent Quotient Quiz to assess each student’s baseline aptitude and identify skills gaps that need to be addressed. • Over forty lively, first person profiles of health care managers working in the field covering everything from educational background and how they first became aware of health care management, through advice to future health care managers. • Detailed appendices that include: resources for learning more about health care management; sample programs of study; job hunting advice; frequently used terms in advertisements, sample position descriptions, do’s and don’ts of interviewing, and a sample cover letter and resume.

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

An invaluable tool equipping healthcare professionals, auditors, and investigators to detect every kind of healthcare fraud According to private and public estimates, billions of dollars are lost per hour to healthcare waste, fraud, and abuse. A must-have reference for auditors, fraud investigators, and healthcare managers, Healthcare Fraud, Second Edition provides tips and techniques to help you spot—and prevent—the "red flags" of fraudulent activity within your organization. Eminently readable, it is your "go-to" resource, equipping you with the necessary skills to look for and deal with potential fraudulent situations. Includes new chapters on primary healthcare, secondary healthcare, information/data management and privacy, damages/risk management, and transparency Offers comprehensive guidance on auditing and fraud detection for healthcare providers and company healthcare plans Examines the necessary background that internal auditors should have when auditing healthcare activities Managing the risks in healthcare fraud requires an understanding of how the healthcare system works and where the key risk areas are. With health records now all being converted to electronic form, the key risk areas and audit process are changing. Read Healthcare Fraud, Second Edition and get the valuable guidance you need to help combat this critical problem.

The rapid growth of home health care has raised many unsolved issues and will have consequences that are far too broad for any one group to analyze in their entirety. Yet a major influence on the safety, quality, and effectiveness of home health care will be the set of issues encompassed by the field of human factors research-the discipline of applying what is known about human capabilities and limitations to the design of products, processes, systems, and work environments. To address these challenges, the National Research Council began a multidisciplinary study to examine a diverse range of behavioral and human factors issues resulting from the increasing migration of medical devices, technologies, and care practices into the home. Its goal is to lay the groundwork for a thorough integration of human factors research with the design and implementation of home health care devices, technologies, and practices. On October 1 and 2, 2009, a group of human factors and other experts met to consider a diverse range of behavioral and human factors issues associated with the increasing migration of medical devices, technologies, and care practices into the home. This book is a summary of that workshop, representing the culmination of the first phase of the study.

The essential concepts of both accounting and financial management are covered in this best-selling healthcare finance book. Through clear explanations, numerous examples, and realistic practice problems, it arms future managers with the grounding they need to make financially sound decisions for their healthcare organizations. This thoroughly updated edition provides more emphasis on the unique marketplace for healthcare services and additional examples from nonhospital settings, including medical practices, clinics, home health agencies, nursing homes, and managed care organizations.

First Edition Awarded Second Place in 2013 AJN Book of the Year Awards! The second edition of this award-winning text, designed specifically for the DNP course in health care economics and finance, remains the only book to embed economic and financial concepts in the context of nursing practice and nursing health care systems. Well organized and clearly written, the second edition is updated to encompass key changes to reimbursement and health care regulations and provides revised statistics throughout. It offers new information on ambulatory care, cost and ratio analysis, additional examples of financial statements, and an updated sample business plan. Enhanced teaching strategies include real life case studies, challenging critical thinking questions, learning games, key words in each chapter, and an extensive glossary. New PowerPoint slides add to the text’s value as a robust teaching tool. Written by experienced DNP executives for DNPs, the book emphasizes critical skills nurse leaders need to participate in strategic health care planning. It delivers a practical approach to business, finance, economics, and health policy that is designed to foster sound business and leadership. The text clearly explicates the relationship between cost of care, quality of care, and ethics, and examines the economic and financial implications of evidence-based practice and quality. Also included is a special section on finance for independent practitioners. Additionally, the book delivers required competencies of the AACN Essentials and the AONE. New to the Second Edition: Updated statistics throughout New information on ambulatory care A cost and ratio analysis Additional examples of financial statements Updated business plan Enhanced faculty support PowerPoint slides

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.