Mastering Healthcare Reimbursement Systems Report: An A to Z Guide to Navigating Payment Models in Healthcare provides case managers and care coordination professionals an easy to reference guide to help you master healthcare reimbursement. You'll learn the wide range of reimbursement systems, from auto liability to workers' compensation and more than a dozen in between. You'll get an overview of utilization management and how that factors into reimbursements, the impact of coding errors, plus a look at the upcoming ICD-10 transformation, resources and more.

Table of Contents:

• Section 1: A-to-Z Guide: Parsing Health Insurance Terminology
  Providing definitions of the terms that make their way into the reimbursement vocabulary, this section provides clarity to what can be complex terms and descriptions.
  
  
• Section 2: Charting the Wide Range of Reimbursement Systems
  From auto liability to workers’ compensation and more than a dozen in between, this section takes a detailed look at the various insurance areas and reimbursement systems available for healthcare consumers today.
  By Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN
  
  
• Section 3: Utilization Review In Review
  This chapter explores the history of utilization management and explains the varied pieces to the puzzle that case manager and care coordination professionals need to understand to complete the picture. Key concepts include provider networks, denials and appeals process, authorization and certification.
  By Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN
  
  
• Section 4: Coding Is Everything: CPT, ICD-9-CM, and EOB
  What common coding errors do you need to know about? How much do claims errors tax the healthcare system? And what strategies can you implement to best protect your clients? This section takes an in-depth look at explanation of benefits, billing and coding systems.
  By Andrew Dean, CPC, CPAR, PAHM, PHIAS
  
  
• Section 5: The ICD Coding System: From the Beginning to the Present
  Providing an historical overview of the formal attempts to successfully classify disease, this section approaches ICD codes from a transitional point of view, culminating with a breakdown of the approaching ICD-10 transformation.
  By Bonnie Schreck, CCS, CPC, CPC-H, CCS-P
  
  
• Section 6: Who's Who in the Healthcare Team
  Understanding the diverse players in the healthcare team, along with their roles and responsibilities, gives case managers the edge in knowing where to turn for securing the best care and resource utilization possible.
  
  
• Section 7: Billing and Reimbursement Resources
  A list of 10 resources that will provide additional education and know-how.