Nelson Higher Education

Higher Education


Health Care Finance and the Mechanics of Insurance and Reimbursement + Navigate 2 Advantage Access, 2nd Edition

  • Michael K. Harrington
  • ISBN-10: 1284169030
  • ISBN-13: 9781284169034
  • 0 Pages | Paperback
  • COPYRIGHT: 2021 Published
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About the Product

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 • Claims Processing • 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)

Table of Contents

Part I:
Chapter 1: Introduction to Healthcare Finance
Chapter 2: Financial Management

Part II:
Chapter 3: Introduction to Claims Processing
Chapter 4: Government Payer Types
Chapter 5: Affordable Care Act
Chapter 6: Managed Care Organizations
Chapter 7: Medicare Prospective Payment Systems
Chapter 8: Hospital Outpatient Prospective Payment System (OPPS)
Chapter 9: Coding for the Non-HIM Professional
Chapter 10: Revenue Cycle Management
Chapter 11: Healthcare Fraud and Abuse
Chapter 12: Electronic Health Records and Meaningful Use
Chapter 13: Government Incentive Programs
Chapter 14:Recovery Audit Contractors
Chapter 15: Introduction to the Mechanics of Hierarchical Condition Categories from a CMS Perspective
Chapter 16: The Application of HCC Coding in a Physician Practice and Lessons Learned

New to this edition

  • 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).