The fifth edition of Principles of Healthcare Reimbursement provides educators, students, and practitioners with
up-to-date information on healthcare payment systems and their effects on the US
healthcare delivery system and economy in one authoritative source. Not only
does the textbook provide step-by-step detail about how each payment system
functions, but the history behind each payment system is also provided. This
publication makes a complex topic understandable for students and practitioners
and helps to clarify the US healthcare reimbursement maze.
New to this Edition
• Alignment with the Affordable Care Act
• Graphics illustrating Medicare payment systems
• Content on prospective payment system for federally qualified health centers (FQHCs)
• Dimensions of performance that can be measured and evaluated
• Expanded content on the charge description
• Covers accessing and using fee schedules, payment classification groups, exclusion lists, market baskets, and wage indexes required for accurate reimbursement
• Explains the various methods, plans, and programs that typify government-sponsored payment systems, commercial insurance, and managed care
• Describes various types of healthcare cost-sharing and their effects on providers and consumers
• Illustrates specialized data collection instruments and electronic submission software used in postacute care
About the Authors
Anne B. Casto, RHIA, CCS, is president of Casto Consulting, LLC.
Elizabeth Forrestal, PhD, RHIA, CCS, FAHIMA, is professor emerita in the Department of Health Services and Information Management at East Carolina University.