Overview

For healthcare providers and patients alike, the ways of private third-party payer payment systems can be mysterious and oftentimes quite frustrating. Payment for hospital, nursing, or homecare services can be subject to a variety of payment systems including cost-based and charge-based or those with payments that are determined in advance. Knowing the specific rules needed to navigate each type of payment system is essential for all healthcare administrators and accountants. Healthcare Payment Systems: Fee Schedule Payment System, the second volume in a series by expert consultant and workshop facilitator Duane Abbey, is dedicated to fee schedule payment systems. Always accessible and entertaining in his approach, Dr. Abbey illustrates the diverse challenges involved with these systems through the discussion of reimbursement claims for several individuals in a fictitious community served by a hospital, a nursing facility, and a hospice among other healthcare providers, Including more than 60 very real scenarios that illustrate best practices for various fee payment challenges, this comprehensive volume -- Explores the general concept of usual, customary, and reasonable (UCR) that is often applied by private third-party payers Provides web links to a number of essential resources including various government acts and manuals Discusses in-depth what is arguably the most complex fee schedule system: the Medicare Physician Fee Schedule Defines a comprehensive list of acronyms used in the medical payment industry Conceptually, fee schedule payment systems are one of the simpler approaches; however, even straightforward healthcare payment systems can, and indeed do, become quite complex. No payment system exists in a vacuum. In fact, when services are provided, the reimbursement from multiple payment systems may be required. This guide shows you how all these systems work, as well as how they interface with one another in everyday practical use. Understanding the differences among systems and learning how to navigate them can make a huge difference in whether a claim is accepted or not and how much payment is allowed.

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9781439840238

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Duane C. Abbey, PhD, CFP, a nationally recognized expert in payment systems, is president of Abbey and Abbey Consultants, Inc. Dr. Abbey works extensively in all areas relating to coding, billing, and reimbursement with particular emphasis on the chargemaster and outpatient payment. His consulting activities include hospitals, clinics, and physicians. Dr. Abbey. Another special area of expertise includes APGs/APCs. He is recognized as the leading expert in the nation in APGs/APCs by the thousands who have attended his seminars, read his publications, and/or contacted him for his services. Recently, he has begun to turn his focus towards Medicare’s new RAC audits.

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