Cost-based, charge-based, and contractual payment systems

This book provides an overview of a wide range of healthcare payment systems. It compares cost-based systems, charge-based payment approaches, and contractually-based payment processes to fee-schedule payment systems and prospective payment systems. It covers claim adjustment and compliance as well as managed care contracts and various combinations of payment systems used by third-party administrators. Examples illustrate the processes used for capitated contract arrangements. The author also addresses various compliance issues, including statutory, contractual, and overpayment issues. - Provided by publisher.