Health Care Finance and the Mechanics of Insurance and Reimbursement

Health Care Finance and the Mechanics of Insurance and Reimbursement 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, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Updated throughout the Third Edition offers expanded material on financial statements; new and expanded Skilled Nursing Facility examples; and enhanced sections on PDPM, Practice Management for Primary Care and other Specialties, Clearinghouse Processes, Predictive Modeling (data mining), and more. Key Features: • Thoroughly covers the methods and process for reimbursement including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing • Prepares health administration and health information management students with the necessary tools to successfully transition from the classroom to the health care facility. • Addresses all the new characteristics of the accounting authorities that the health care administrator will have to deal with after the COVID-19 Pandemic. • Includes a full chapter on the ACA that addresses recent and anticipated future changes that could impact not only the patient but the various health care organizations that provide care in the inpatient and outpatient settings.