Hospital Reimbursement: Concepts and Principles PDF

Preface

Throughout my 12 years in the healthcare accounting field, I have read many books and articles that detail the numerous leadership strategies, physician integration methods, and healthcare reform issues that are applicable to being an effective hospital administrator. However, I found minimal literature on the fiscal concepts and reimbursement models that hospital leaders should understand. I have found few resources that explain how to complete a Medicare cost report or how to estimate a patient receivable. Indeed, there is a wealth of information that details billing requirements and coding guidelines, but there is little subject matter that details the revenue cycle as it specifically pertains to a hospital. The hospital reimbursement process is by far the most complex of any industry due to the numerous variables that affect revenue and cost. There are few businesses in which the bill is not paid by the client, and identical services may be paid at a lower or higher rate depending on insurance type. An additional factor is that hospital reimbursement is heavily affected by governmental regulation. I have attempted to formulate an easy-to-read text that any individual can use to better understand the various reimbursement methods that exist within a hospital setting. It helps to have a working knowledge of the accounting field before you read this book, but it is not a requirement. Several concepts and models in this book may seem overwhelming if the reader does not have at least an elementary financial background. I have included several boxed items, labeled "Critical Issue," to emphasize an important topic. I have also included several diagrams and flowcharts that I hope will make the process easier to understand. For your convenience, the forms in Chapter 8 are available at http://www.crcpress.com/product/ isbn/9781439898949.

The actual process of reimbursement is defined as the repayment to a provider after services have been rendered. Healthcare is the only business that is compensated for services after the client has left the facility. In some cases, reimbursement for care is prospective in that the hospital knows what the payment will be regardless of the costs to treat the patient. The healthcare delivery system in the United States is complex not only because of the numerous reimbursement methods but also because of the link among health insurance, income, and the government. Numerous models are used to pay not only hospitals but also physicians, nursing homes, and other healthcare entities.

My goal is that, after reading this book, you will have a better technical understanding of the complex field known as hospital reimbursement. This dynamic industry is constantly evolving as the federal government continuously researches new methods to reduce health care costs while attempting to expand coverage for all citizens. Despite these modifications, the debits and credits of double-entry accounting have not changed, and assets will still equal liabilities plus equity. I hope that these chapters provide a better understanding of a field that few comprehend.