Health Care Finance and the Mechanics of Insurance and Reimbursement stands apart from other texts on health care finance or health insurance, in that it combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle in detail, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation.
Thoroughly updated for its second edition, this text reflects changes to the Affordable Care Act, Managed Care Organizations, new coding initiatives, new components of the revenue cycle (from reimbursement to compliance), updates to regulations surrounding health care fraud and abuse, changes to the Recovery Audit Contractors (RAC) program, and more.
Designed to prepare health administration and health information management students with the necessary tools to successfully transition from the classroom to the health care facility, this text includes:
' Basics of Health Care Finance & Financial Management
' Claims Processing
' Patient Protection and the Affordable Care Act
' Managed Care Organizations
' Medicare Prospective Payment System (Inpatient)
' Hospital Outpatient Prospective Payment Systems (OPPS)
' Coding for the Non-HIM Professional
' Revenue Cycle Management
' Healthcare Fraud and Abuse
' Electronic Health Records and Meaningful Use
' Government Incentive Programs
' Recovery Audit Contractors (RAC)
Author Biography:
Michael K. Harrington, MATS, MSHA, RHIA, CHP, has more than 30 years of experience in health care in areas such as Health Information Management, managing homecare companies on a local and regional level, and consulting in the post-acute sector. He is a leading authority on healthcare reimbursement and Revenue Cycle Management (RCM) and has extensive experience in implementing the RCM model in physicians’ offices and other healthcare organizations outside of the acute-care setting. After starting out in the healthcare field in a home care company as a coordinator, Harrington quickly advanced into managing home care companies that handled durable medical equipment, specialty home infusion, high-tech respiratory services, and specialty biologicals, and repositioned these companies by using reimbursement and quality clinical care as the cornerstones to his success. In addition to managing home care companies, Harrington started to teach and was part of the adjunct faculty at Gwynedd Mercy College, Temple University, and St. Joseph’s University in the Philadelphia area. His focus has always been in healthcare reimbursement when teaching, but he has instructed in other areas, such as Healthcare Policy, Healthcare Ethics, Healthcare Delivery, Computerized Medical Records, and Healthcare Law. Recently, Harrington has been named Program Director over the Health Administration Department for St. Joseph’s College of Maine. His responsibilities include the Undergraduate Health Administration, Health Information Management, Long-Term Care, Radiologic Science Administration Programs, and a Graduate Level Health Administration Program. Harrington earned his bachelor’s degree from LaSalle College and his master’s degree from Independence University (formerly California College for Health Sciences). Harrington also earned his Registered Health Information Management (RHIA) credentials at Alabama State University. He is an active patient advocate and is a much soughtafter speaker, on a global basis, in the areas of healthcare reimbursement, healthcare finance, and healthcare operations. He can be reached at michaelharrington@sjcme.edu.
