Open Access. Powered by Scholars. Published by Universities.®
Articles 1 - 2 of 2
Full-Text Articles in Law
Revenue-Cycle Management And Reimbursement: The Impact Of Health Law And Health Reform On Providers, Timothy D. Martin
Revenue-Cycle Management And Reimbursement: The Impact Of Health Law And Health Reform On Providers, Timothy D. Martin
Timothy D Martin
Healthcare payment systems are complex and difficult to administer. Over the years, providers have developed a complex process, called revenue-cycle management, for administering their interactions with payers operating under various payment systems. The Patient Protection and Affordable Care Act of 2010 will have a significant impact on payment systems—as will other recent reform measures. This paper contains primers on revenue-cycle management, health insurance systems, medical claims, claim coding, electronic-data interchange (EDI), claims processing, and public and private reimbursement methods for hospitals and physicians. But its focus is on the impact recent healthcare reform initiatives have had and are likely to …
Relating Diagnosis-Related Groups: What Germany And The United States Can Learn From Each Other About Aute-Care Payment Systems, Timothy D. Martin
Relating Diagnosis-Related Groups: What Germany And The United States Can Learn From Each Other About Aute-Care Payment Systems, Timothy D. Martin
Timothy D Martin
In recent years, several countries have adopted diagnosis-related group (DRG) payment systems modeled after the system Medicare uses to reimburse providers for acute-care inpatient treatment. This paper compares the Medicare DRG system with the German DRG system and suggests improvements that might help both systems. First, Germany should proceed carefully in its attempt to reduce the length of hospital visits because its universal payment mechanism cannot shift costs to the private sector so inadequate payment could degrade the quality of care. Second, because both countries struggle with incorporating new treatments and technologies into their payment systems, they should both consider …