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1000 tulosta hakusanalla Duane Watari
Medicare fraud is big business, but while only a few profit from intentional malfeasance, the Centers for Medicare & Medicaid Services is now taking a closer look at everyone. The Medicare Recovery Audit Contractor Program, already infamously known as the RAC, swings into full operation in 2010 and every healthcare provider that receives payment under any of the Medicare fee-for-service payment systems will be subject to RAC scrutiny. And scrutinize, they will… .Instead of developing another bureaucracy, the government has turned the job of auditing over to outside firms whose payment will be based exclusively on finder fees for recouping improper payments. There will be little tolerance for poor record keeping or gray areas of coding.Written by medical billing guru and Lean accounting expert, Duane Abbey, The Medicare Recovery Audit Contractor Program: A Survival Guide for Healthcare Providers explains all that is required to prepare and successfully defend against inappropriate RAC audit recoveries. Using the same succinct style that always makes his writing so accessible, Abbey illustrates his lessons with simple case studies placed in the context of a fictitious community whose population is served by a hospital, clinics, a nursing facility, and other providers all seeking to maintain compliance and profitability.In discussing RAC guidelines, this resource — Shows how to identify overpayment areas and associated compliance issuesDetails a systematic problem-solving process relative to RAC processes Addresses resource requirements including new personnel, such as RAC specialists Includes planning models for developing compliance departments Provides an extensive glossary to make sense of medical billing’s alphabet soup of acronymsWhile the book works well as a stand-alone reference for those seeking advice on RAC audits, readers will also discover that this volume extends the lesson of Abbey’s classic Compliance for Coding, Billing & Reimbursement, Second Edition , making this book a natural companion for those wanting to fully explore the role of compliance and Lean accounting in medical billing.
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 manualsDiscusses in-depth what is arguably the most complex fee schedule system: the Medicare Physician Fee ScheduleDefines a comprehensive list of acronyms used in the medical payment industryConceptually, 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.
Cost-Based, Charge-Based, and Contractual Payment Systems
Duane C. Abbey
Productivity Press
2012
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The fourth book in the Healthcare Payment System series, Cost-Based, Charge-Based, and Contractual Payment Systems compares cost-based systems, charge-based payment approaches, and contractually-based payment processes with fee-schedule payment systems and prospective payment systems. Supplying readers with a clear understanding of important background material on the different types of healthcare providers, it covers the basics of cost-based, charge-based, and contractual payment systems. The book illustrates essential concepts with a series of simple case studies—making it ideal for anyone interested in learning more about the specific systems and processes used for payment in healthcare services. It discusses Medicare cost-based payment systems, Medicare payment approaches, and includes an appendix that outlines the various Medicare payment systems. Demystifying contractual language, it outlines managed care contracts and also: Delves into the intricacies involved with adjudication of claimsConsiders capitated payment systemsAddresses healthcare costs and cost-based reimbursement systemsExamines charge-based and contractual payment systemsDescribes where healthcare payment systems are headed in the futureSince compliance is inherent throughout the process of providing services, filling claims, and receiving payment, the book examines the range of compliance concerns, including statutory, contractual, and overpayment issues. Using numerous examples to illustrate the processes used for capitated contract arrangements, the book includes coverage of claim adjustment, managed care contracts, and the various combinations of payment systems used by third-party administrators.
The third book in the Healthcare Payment Systems series, Prospective Payment Systems examines the various types of prospective payment systems (PPS) used by healthcare providers and third-party payers. Emphasizing the basic elements of PPS, it considers the many variations of payment for hospital inpatient and outpatient services, skilled nursing facilities, home health agencies, long-term hospital care, and rehabilitation facilities along with other providers. The book describes the anatomy of PPS, including cost reports, adjudication features and processes, relative weights, and payment processes. It outlines the features and documentation requirements for Medicare Severity Diagnosis Related Groups (MS-DRGs), the Medicare Ambulatory Payment Classifications (APCs), Medicare HHPPS, Medicare Skilled Nursing Resource Utilization Groups (RUGs), and private third-party payers. Provides a framework for understanding and analyzing the characteristics of any PPSDiscusses Medicare prospective payment systems and approachesIncludes specific references to helpful resources, both online and in printFacilitates a clear understanding of the complexities related to PPS—covering specific topics at a high level and revisiting similar topics to reinforce understandingComplete with a detailed listing of the acronyms most-commonly used in healthcare coding, billing, and reimbursement, the book includes a series of case studies that illustrate key concepts. It concludes with a discussion of the challenges with PPS—including compliance and overpayment issues—to provide you with the real-world understanding needed to make sense of any PPS.
Illuminating the moral views on violence, from the moral restraint of the just-war tradition through pragmatic nonviolence to principled variations of pacifism
Illuminating the moral views on violence, from the moral restraint of the just-war tradition through pragmatic nonviolence to principled variations of pacifism
This information is not available at this time. Author will provide once available.
This information is not available at this time. Author will provide once available.
Fundamentals of Biomechanics, 2nd edition, presents a clear, conceptual approach to understanding biomechanics within the context of the qualitative analysis of human movement. The philosophy is to blend up-to-date biomechanical knowledge (with extensive referencing for student study) with professional application knowledge. This true application of biomechanics in real-world settings is missing in previous biomechanics texts. The text provides real-world examples of the application of biomechanics several ways. Like other texts, human movement examples and problems are discussed to help teach biomechanical variables and concepts. This text, however, goes beyond this physics class with sport example approach. First, nine principles of biomechanics are developed throughout the book to link theoretical knowledge with practical/professional principles and application. These nine generic application principles are based on the laws and concepts of biomechanics, so they can be applied to all human movements. There principles help PETE majors address standard 2 on applying movement concepts and principles in physical education (NASPE, 1995). Most biomechanics texts that have tried to develop principles for application have created many specific observations about many categories of human movement, so students tend to get lost. Second, the last section of the book develops the application of biomechanics in qualitative analysis of several movements in four professional areas: physical education, coaching, strength & conditioning, and sports medicine. These guided tours of the application of biomechanics to solve human movement problems are similar to the extensive interdisciplinary qualitative analysis tutorials in Knudson & Morrison (2002).
Misdiagnosed, misunderstood and oftentimes entirely overlooked, the obscurity surrounding personality disorders can debilitate as much as the disorders themselves. Using case study examples throughout, this book illustrates the nature and reality of personality disorders and how they play out in the daily lives of those living with them as well as their family members, coworkers, and friends. By explaining the warning signs along with how such disorders might develop, Dobbert demonstrates how personality disorders can be effectively addressed and treated. Distinguishing between the accepted psychological criteria for disorders and the everyday upsets that some might wrongfully determine to be personality disorders, he carefully outlines the contours of such disorders and how to recognize and address them when they arise. In accessible style, Dobbert offers the reader a clear, succinct, and careful overview of the various disorders and what they mean for all those affected by them.
Mulholland Books presents... FUN AND GAMESNUMBER OF ACCIDENTAL DEATHS PER YEARBy suffocation: 3,300By poisoning: 8,600STAGED BY PROFESSIONALS: You have no idea.Ex-cop Charlie Hardie's latest job is guarding an isolated mansion in LA's Hollywood Hills. But it comes with an unwanted guest - a D-list actress who says she's being hunted by professional hitmen.Charlie thinks she's just high and paranoid.But he's wrong.The killers are real.They've tracked her to the house. And they're not letting anyone out alive.
Mulholland Books presents... HELL AND GONEThere are some criminals so dangerous the world can never know about them.They can't be held in regular prisons.They must never be released.They're here - in a secret underground prison miles away from anywhere. And now, so is Charlie Hardie. The shadowy organisation running the jail sent him there as punishment for getting in their way. But he's not a prisoner. He's in charge. He can leave any time he wants, he's told. There's just one catch: if he goes, everyone in the prison dies, including innocent guards.But when Charlie realises his family may be in danger, he knows he must protect them at any cost. Even if it means blasting his way out, one inmate at a time...
On a day like any other, Kendra Hardie picks up the phone. A voice says, 'leave the house and you're dead'. Then the line is cut.Kendra hasn't seen her husband Charlie for nearly a decade. He hasn't forgotten about her - but neither have his enemies. And he has a lot of enemies. Charlie thought he could protect her by staying away. But now he has access to secrets his enemies will kill to keep hidden, and they're planning to start with his family. After years in exile, Charlie's arming up... and heading home.
Grad student by day; criminal informant by night - Sarie Holland is a new breed of action hero.
Three generations - torn apart by one bullet. Philadelphia 1965: Two street cops - one black, one white - are gunned down in a robbery gone wrong. The killer is never prosecuted. One of the fallen officers, Stanislaw Walczak, leaves behind a twelve-year-old boy, Jimmy... Philadelphia 1995: Homicide detective Jim Walczak learns that his father's alleged killer, Terrill Lee Stanton, is out of prison. Walczak will be waiting, determined to squeeze the truth out of him - any way he can. Philadelphia 2015: Jim Walczak's daughter Audrey, studying forensic science in grad school, reinvestigates her grandfather's murder for her dissertation. But the deeper Audrey digs, the more she realises: the man everyone thinks killed Walczak didn't do it...And when the truth comes out, the danger's only going to grow.
