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.

Designed to prepare health administration and health information management students with the necessary tools to successfully transition from the classroom to the health care facility, this text includes:

- Basics of Health Care Finance & Financial Management
- Patient Protection and the Affordable Care Act
- Managed Care Organizations
- Medicare Prospective Payment System (Inpatient)
- Hospital Outpatient Prospective Payment Systems (OPPS)
- Coding for the Non-HIM Professional
- Revenue Cycle Management
- Healthcare Fraud and Abuse
- Electronic Health Records and Meaningful Use
- Government Incentive Programs
- Recovery Audit Contractors (RAC)

Two new chapters cover the mechanics of hierarchical condition categories from a CMS perspective (15), and the application of HCC coding in a physican practice (16).