Principles of Healthcare Reimbursement and Revenue Cycle Management

By: Anne B. Casto

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Synopsis: Health information management (HIM) professionals play a crucial role in the delivery of healthcare services in the US. However, to be fully effective in their roles, HIM professionals need an in-depth understanding of healthcare reimbursement systems, reimbursement methodologies, and payment processes throughout the healthcare industry. Principles of Healthcare Reimbursement and Revenue Cycle Management makes complex topics understandable for students and professionals by clarifying the US healthcare reimbursement maze. This text integrates information about US healthcare reimbursement methodologies and processes into one authoritative source. It examines the complex financial systems within today’s healthcare environment and provides an understanding of the basics of health insurance and public funding programs, managed care concepts, and how services are paid. Step-by-step details about how claims are processed, managed, and paid are provided. This gives the reader an appreciation for the complexity of the healthcare reimbursement process and an understanding of the profound effect reimbursement methodologies and policies have had on healthcare professionals and payers, consumers, public-sector policymakers, and the development of classification and information technology systems over the years.