Healthcare Payment Systems: An Introduction

The skill levels of financial workers can vary as much as those of medical personnel, and the impact that these workers have on the viability, let alone profitability and efficient running, of any hospital, medical practice or facility is quite profound. The common belief now is that the multitude of payment systems that every medical practitioner must access, with their diverse procedures and hundreds if not thousands of medical codes, are scarcely manageable. However, with the right knowledge and the right approach, you can turn a system that controls you into one that you control.

Healthcare Payment Systems: An Introduction provides a complete introduction to healthcare payment systems. Written by Duane Abbey, one of the nation’s leading experts and most sought out consultants in payment systems, this volume makes the monumental task of medical reimbursement approachable and manageable. Covering all the fundamentals and terminology needed to understand this discipline, and the insight and strategies needed to master it, Dr. Abbey ―

• Provides a detailed understanding of the differences among healthcare payment systems
• Shows you the best ways to categorize specific third-party payer requirements
• Explains what you need to know about Medicare’s use of different payment systems
• Gives you the understanding needed to negotiate better contractual arrangements

This self-contained guide is more than a reference. It provides an overview and discussion of topics that one must understand to optimize usage of various systems. Ultimately, it will help you begin to develop the solid core of skills and knowledge needed to confidently approach payment systems as tools to use rather than hazards to avoid -- tools that will lead to improved revenue cycles and higher levels of profitability.

This book is the first in Dr. Abbey’s Healthcare Payment System Series from Productivity Press. Look for future books in the series covering a variety of service-specific payment systems for physicians, hospitals, and specialized programs.

Duane C. Abbey, PhD, CFP, is a management consultant and president of Abbey & Abbey Consultants, Inc., a consulting firm specializing in health care. 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.

In addition to his consulting practice, Dr. Abbey also teaches workshops and makes presentations on a regular basis. He has taught at the University level and speaks nationally. He is a regular presenter for hospital associations, medical societies, Boards of Trustees and various other organizations and groups. In addition, professional societies such as HFMA use Dr. Abbey's services to present seminars and workshops.

Dr. Abbey is a nationally recognized expert in payment systems. A 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 contracted for his services. Attendees at these seminars over the years have included personnel from hospitals, clinics, integrated delivery systems and multiple consulting firms.

Dr. Abbey is also the author of numerous articles and books including: Compliance for Coding, Billing & Reimbursement, Outpatient Services: Designing, Organizing & Managing Outpatient Resources, ChargeMaster: Review Strategies for Improved Billing and Reimbursement, Ambulatory Patient Group Operations Manual, published by McGraw-Hill and Non-Physician Providers: Guide to Coding, Billing & Reimbursement, Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance, and Emergency Department Coding &Billing: A Guide to Reimbursement & Compliance published by HCPro.