Cost-Based, Charge-Based, and Contractual Payment Systems

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 studies—making 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

90000

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 s.co m

K13380

COST-BASED, CHARGE-BASED, AND CONTRACTUAL PAYMENT SYSTEMS

Duane C. Abbey

Cost-Based, Charge-Based, and

Contractual Payment Systems

ABBEY

HEALTHCARE PAYMENT SYSTEMS

K13380 cvr mech.indd 1 7/10/12 1:00 PM