Skip to Main Content
Healthcare Valuation: The Four Pillars of Healthcare Value, Volume 1
book

Healthcare Valuation: The Four Pillars of Healthcare Value, Volume 1

by Robert James Cimasi
April 2014
Intermediate to advanced content levelIntermediate to advanced
752 pages
21h 13m
English
Wiley
Content preview from Healthcare Valuation: The Four Pillars of Healthcare Value, Volume 1

CHAPTER 2

Reimbursement Environment

2.1 Overview

2.2 Healthcare Revenue Cycle

2.2.1 Step 1: Scheduling and Registration

2.2.2 Step 2: Patient Encounter Forms

2.2.3 Step 3: Diagnostic and Procedural Coding

2.2.4 Step 4: Charge Entry

2.2.5 Step 5: Primary Insurance Billing

2.2.6 Step 6: Secondary Insurance Billing

2.2.7 Step 7: Patient Responsibility

2.2.8 Step 8: Claims Resolution

2.2.9 Step 9: Collections

2.3 Current Reimbursement Environment

2.4 Public Payors

2.4.1 Medicare

2.4.2 Medicaid and CHIP

2.4.3 Dual Eligibles

2.4.4 TRICARE (CHAMPUS)

2.4.5 Civilian Health and Medical Program of the Department of Veteran Affairs (CHAMPVA)

2.4.6 Other Public Payors

2.5 Private Payors

2.5.1 For-Profit Commercial Insurers

2.5.2 Not-for-Profit Commercial Insurers

2.6 Methods of Reimbursement

2.6.1 Cost of Care

2.6.2 Fee-for-Service (FFS)

2.6.3 Pay-for-Performance (P4P)

2.6.4 Capitation

2.6.5 Payor Mix and the Effect on the Revenue Cycle

2.7 Emerging Reimbursement Trends and the Impact of Healthcare Reform

2.7.1 Shift from Fee-for-Service

2.7.2 ACOs

2.7.3 Patient-Centered Medical Homes

2.7.4 Vermont's Single Payor Insurance System

2.8 Conclusion

2.9 Key Sources

2.10 Acronyms

2.1 OVERVIEW

Healthcare reimbursement may be defined as the payment received by providers for the services they render to patients. Most providers will receive reimbursements for their services from commercial payors and other third parties, including, but not limited to, patients, employers, insurance companies, and ...

Become an O’Reilly member and get unlimited access to this title plus top books and audiobooks from O’Reilly and nearly 200 top publishers, thousands of courses curated by job role, 150+ live events each month,
and much more.
Start your free trial

You might also like

Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services, Volume 2

Healthcare Valuation: The Financial Appraisal of Enterprises, Assets, and Services, Volume 2

Robert James Cimasi
Information Technology for Patient Empowerment in Healthcare

Information Technology for Patient Empowerment in Healthcare

Maria Adela Grando, Ronen Rozenblum, David Bates, Thomas Lee, Mehnaz Adnan, Wajeeh Bajwa, Marion J. Ball, Sasha Ballen, Cynthia Baur, Asaf Bitton, John Jeffrey Carr, Scott Cashon, Catalina Danis, Mary Jo Deering, Robert Farrell, Yaorong Ge, Stephanie Glier, C. Martin Harris, Jeff Harwell, David Lansky, Gene Lazuta, Gondy Leroy, Peter Lucas, Ariane Marelli, Mary McNamara, Michael L. Millenson, Marjorie Miller, Paula Miller, Martha Minniti, Jihad Obeid, Disty Pearson, Christopher Pentoney, Margaret Piscitelli, Michael Poku, Jane Sarasohn-Kahn, Yukari Schneider, Roy Schoenberg, Hanna Suominen, Maarten van der Heijden, Marina Velikova, Jim Warren, Eyal Zimlichman
Digital Future of Healthcare

Digital Future of Healthcare

Nilanjan Dey, Nabanita Das, Jyotismita Chaki

Publisher Resources

ISBN: 9781118292792Purchase book