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Part I: Foundations of Healthcare Reimbursement

1. Healthcare Reimbursement and Revenue Cycle Management
2. Health Insurance
3. Government-Sponsored Healthcare Programs

Part II: Reimbursement Methodologies and Payment Systems

4. Healthcare Reimbursement Methodologies
5. Medicare Hospital Acute Inpatient Payment System
6. Medicare Skilled Nursing Facility Services Payment System
7. Medicare Outpatient Hospital Payment System
8. Medicare Physician and Other Health Professional Payment System

Part III: Revenue Cycle Processes

9. Revenue Cycle Front End Processes—Patient Engagement
10. Revenue Cycle Middle Processes— Resource Tracking
11. Revenue Cycle Back-End Processes— Claims Production and Revenue Collection

Part IV: Revenue Cycle Management

12. Coding and Clinical Documentation Integrity Management
13. Revenue Compliance

Part V: Revenue Cycle Analysis

14. Healthcare Data in Action: Real-World Analysis

Appendix A: Abbreviation List
Appendix B: Glossary
Appendix C: Answer Key for Check Your Understanding Questions
Appendix D: CMS 1500 Claim Form
Appendix E: CMS 1450 (UB-04) Claim Form
Appendix F: Medicare Summary Notice
Index

On the Website:

Chapter 15: Payment Systems for Specialty Settings
Appendix G: Review of Mathematics and Statistics Methods

Instructor Resources include the following:

• Instructor manual
• Test bank and supplementary mini quizzes
• Presentation slides and supplementary mini slide decks
• A map to the Ä¢¹½ÊÓƵ HIM curricula competencies
• Transition guide

Student Resources include:

• Student Workbook
• Activity Files

The test bank is also available in Respondus.

Anne B. Casto, RHIA, CCS, is president of Casto Consulting, LLC, and a lecturer in the HIMS division at The Ohio State University School of Allied Medical Professions.

Susan White, PhD, RHIA, CHDA, is a clinical professor in the health information management and systems department at The Ohio State University.