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Hospital Reimbursement

  • Fester Einband
  • 272 Seiten
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Kyle Herbert has over 18 years of healthcare accounting experience, and he is licensed as both a CPA (certified public accountant)... Weiterlesen
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Kyle Herbert has over 18 years of healthcare accounting experience, and he is licensed as both a CPA (certified public accountant) and a CMA (certified management accountant). Kyle is a received his undergraduate degree from the University of Richmond and his master's degree in business administration from The Citadel. In addition to these academic achievements, Kyle attained fellowships with both the Healthcare Financial Management Association and the American College of Healthcare Executives. Kyle is a member of the American Institute of Certified Public Accountants, the Institute of Management Accountants, the South Carolina Society of Accountants, and the South Carolina Association of CPAs.Mr. Herbert is also a Fulbright Scholar who was a visiting professor in Bangkok, Thailand.He can be reached with questions or comments at: Columbia-17@hotmail.com


Hospital reimbursement is a complex field that is driven by numerous factors and variables. This easy-to-read text provides a clear understanding of the concepts and principles that drive the revenue cycle within a hospital setting.

Due to the countless variables that affect revenue and cost, the hospital reimbursement process is by far the most complex of any industry. Requiring only a basic financial background and a working knowledge of accounting, Hospital Reimbursement: Concepts and Principles supplies a clear understanding of the concepts and principles that drive the revenue cycle within a hospital setting. The book explains the technical aspects of reimbursement in language that is easy to comprehend. It illustrates the complexities of the hospital revenue cycle and explains the Medicare and Medicaid financial models in detail. The text also addresses the Medicaid reimbursement methodology, the formulation of the Medicare blend rate, the computation of both DSH and IME, as well as other third-party payers. It also: Covers the full range of services and procedures for which a hospital can receive reimbursement Explains the difference between a for-profit and not-for-profit hospital Contains chapters devoted to Statements of Operations (Income Statement) and Statements of Financial Position (Balance Sheet) Examines governmental cost reportingincluding Worksheets A, A-6, A-8, A-8-2, B-1, B Part 1, C Part 1, D-3, D-5, and E Part A Supplying readers with a foundation in coding principles, the text also includes a model for calculating the financial impact of variations in patient length of stay. It discusses the DRG and APC reimbursement models and details the computation of an outlier payment. In addition, it walks the reader step-by-step through the creation of a mock Medicare cost report for a sample hospital.

Fundamentals of AccountingIntroductionHistory and FrameworkAccounting ServicesAuditingFinancial Concepts and TerminologyAdditional Financial TermsFinancial StatementsBudgetingCost AccountingInventory ManagementSensitivity AnalysisRelative Sales ValueOther RatiosConclusionReferences Types of Hospitals/Conceptual FrameworkHistory and IntroductionNot-for-Profit HospitalsUnrelated Business IncomeFor-Profit HospitalsGovernment-Owned HospitalsBoard of DirectorsSenior ManagementCertificate of NeedHospital ConsolidationConclusionReferences Hospital Revenue CycleIntroductionPatient AccessBillingRevenue Sources (Payers)Payer MixMedical RecordsCase Management/Utilization ReviewCash CollectionsHospital ContractingFraud/AbuseRecovery Audit ContractorsForm 990ConclusionReferences Hospital ServicesIntroductionInpatient/OutpatientFacility/Professional FeeEmergency RoomSurgeryCardiologyWomen's Services/Birthing UnitNeonatal Intensive Care UnitOncologyRadiologyPharmacyLaboratoryObservation DaysNursing Homes, Skilled Nursing Facility, Hospice CareHome Health CareAdministrative Days/Swing BedsOsteopathic MedicineConclusion MedicareIntroduction and HistoryCost SharingInpatient Prospective Payment System/Diagnosis-Related GroupOutpatient Prospective Payment System/APC Fee ScheduleCase Mix IndexMedicare Blend RateMedicare Disproportionate Share Add-OnIndirect Medical Education Add-OnCapital Portion of the Blend RateOutlier PaymentsMedicare Pass-ThroughMedicare Eligible DaysAdditional IssuesConclusion MedicaidIntroductionReimbursementMedicaid Add-On PaymentsMedicaid Teaching Supplement and TraumaHierarchy of Indigent PatientsMedicaid Cost SettlementMedicaid Disproportionate Share CalculationState Children's Hospital Insurance ProgramConclusion Other Insurance ProvidersIntroductionManaged Care (Health Maintenance Organization versus Preferred Provider Organization)Blue Cross/Blue ShieldTRICAREWorkers' CompensationVeterans AffairsConclusionReferences Governmental Cost ReportingIntroductionWorksheet AWorksheet A-6Worksheet A-8Worksheet A-8-1Worksheet A-8-2Worksheet A-7Worksheet B-1Worksheet B Part 1Worksheet B Parts 2 and 3Worksheet CWorksheet DWorksheet EMedicare Bad DebtMedicare DSH CalculationWorksheet E Part AWorksheet E Part BSubprovider (Psychiatric and Rehabilitation)ClinicsConclusion Statement of Operations (Income Statement)IntroductionGross RevenueNet RevenueOther RevenueOperating ExpensesBad DebtResponsibility AccountingVariance AnalysisPayrollConclusionStatement of Financial Position (Balance Sheet)IntroductionCashAccounts ReceivableInventoriesInvestmentsProperty and Equipment (Fixed Assets)Accounts PayableLong-Term DebtOther LiabilitiesNet AssetsStatement of Changes in Net AssetsStatement of Cash FlowsFinancial Statement NotesConclusionReference CodingIntroductionCharge Description MasterInpatient CodingOutpatient CodingPricingCharge FlowchartCoding AccuracyConclusion Managing the Month-End Close ProcessReference Calculating the Financial Impact of Hospital Length of StayIntroductionHospitalist LOSConclusionReference The Future of Healthcare AccountingIntroductionJob SecurityAccountable Care OrganizationPatient-Centered CareBundled PaymentsConclusion EpilogueIncorporating Faith in the WorkplaceAppendix A: UB-04 Revenue CodesAppendix B: FYE 2010 Medicare MS-DRG Listing Index


Titel: Hospital Reimbursement
Untertitel: Concepts and Principles
EAN: 9781439898949
ISBN: 978-1-4398-9894-9
Format: Fester Einband
Herausgeber: Taylor and Francis
Genre: Medizin
Anzahl Seiten: 272
Gewicht: 680g
Größe: H254mm x B178mm
Jahr: 2012