Business & Management / Healthcare Financial Management & Leadership
The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based,
and Contractual Payment Systems compares cost-based systems, charge-based payment
approaches, and contractually-based payment processes with fee-schedule payment systems
and prospective payment systems. Supplying readers with a clear understanding of important
background material on the different types of healthcare providers, it covers the basics of
cost-based, charge-based, and contractual payment systems.
The book illustrates essential concepts with a series of simple case studiesmaking it ideal
for anyone interested in learning more about the specic systems and processes used for
payment in healthcare services. It discusses Medicare cost-based payment systems, Medicare
payment approaches, and includes an appendix that outlines the various Medicare payment
systems. Demystifying contractual language, it outlines managed care contracts and also:
• Delves into the intricacies involved with adjudication of claims
• Considers capitated payment systems
• Addresses healthcare costs and cost-based reimbursement systems
• Examines charge-based and contractual payment systems
• Describes where healthcare payment systems are headed in the future
Since compliance is inherent throughout the process of providing services, lling claims,
and receiving payment, the book examines the range of compliance concerns, including
statutory, contractual, and overpayment issues. Using numerous examples to illustrate the
processes used for capitated contract arrangements, the book includes coverage of claim
adjustment, managed care contracts, and the various combinations of payment systems used
by third-party administrators.
ISBN: 978-1-4398-7299-4
9 781439 872994
w w w. p r o d u c t i v i t y p r e s s . c o m
www.c rc pres m
Duane C. Abbey
Cost-Based, Charge-Based, and
Contractual Payment Systems
K13380 cvr mech.indd 1 7/10/12 1:00 PM

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