Relevant bibliographies by topics / Health care reimbursement

Contents

  1. Journal articles
  2. Dissertations / Theses
  3. Books
  4. Book chapters
  5. Conference papers
  6. Reports

Academic literature on the topic 'Health care reimbursement'

Author: Grafiati
Published: 4 June 2021
Last updated: 5 February 2022

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Journal articles on the topic "Health care reimbursement"

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Levi, Shoshana, Emily Alberto, Dakota Urban, Nicholas Petrelli, and Gregory Tiesi. "Health-Care Workers’ Perception of Reimbursement for Complex Surgical Oncology Procedures." American Surgeon 86, no. 2 (February 2020): 140–45. http://dx.doi.org/10.1177/000313482008600234.

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Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers’ views. Our study examined health-care workers’ perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures—hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60–64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.
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Hilt, Robert J. "Reimbursement for Primary Care Mental Health." Pediatric Annals 42, no. 10 (October 1, 2013): 394. http://dx.doi.org/10.3928/00904481-20130924-03.

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Preskitt, John T. "Health Care Reimbursement: Clemens to Clinton." Baylor University Medical Center Proceedings 21, no. 1 (January 2008): 40–44. http://dx.doi.org/10.1080/08998280.2008.11928358.

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Cowan, Dale H. "Legal aspects of health care reimbursement." Journal of Legal Medicine 6, no. 4 (December 1985): 553–62. http://dx.doi.org/10.1080/01947648509513460.

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Barros, Pedro Pita, and Xavier Martinez-Giralt. "Technological Adoption in Health Care – The Role of Payment Systems." B.E. Journal of Economic Analysis & Policy 15, no. 2 (April 1, 2015): 709–45. http://dx.doi.org/10.1515/bejeap-2014-0113.

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Abstract This paper examines the incentive to adopt a new technology resulting from common payment systems, namely mixed cost reimbursement and DRG reimbursement. Adoption is based on a cost–benefit criterion. We find that retrospective payment systems require a large enough patient benefit to yield adoption, while under DRG-linked payment, adoption may arise in the absence of patients benefits when the differential reimbursement for the old vs new technology is large enough. Also, mixed cost reimbursement leads to higher adoption under conditions on the differential reimbursement levels and patient benefits. In policy terms, mixed cost reimbursement system may be more effective than a DRG payment system to induce technology adoption. Our analysis also shows that current economic evaluation criteria for new technologies do not capture the different ways payment systems influence technology adoption. This gives a new dimension to the discussion of prospective vs retrospective payment systems of the last decades centered on the debate of quality vs cost containment.
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Melzer, S. M., and S. R. Poole. "Reimbursement for Telephone Care." PEDIATRICS 109, no. 2 (February 1, 2002): 290–93. http://dx.doi.org/10.1542/peds.109.2.290.

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Wilamowsky, Yonah, Aliza Rotenstein, and Sheldon Epstein. "Developing Transparent Health Care Reimbursement Auditing Procedures." Journal of Business Case Studies (JBCS) 10, no. 1 (December 31, 2013): 1–6. http://dx.doi.org/10.19030/jbcs.v10i1.8323.

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The continued computerization of health care records has enabled easier sampling and analysis of large sets of medical records, making it easier than ever for Medicare, Medicaid and other private insurers to use statistical audits to determine and demand return of alleged overpayments to health care providers. However, there are sometimes statistical difficulties with the audits, and there is frequently not sufficient transparency in the procedures or their application to reproduce the results in order to determine whether they have been carried out correctly. This paper addresses concerns in sampling and analysis of data records by looking at the case of a specific audit of a medical practice carried out by a private insurer. If done properly, statistical audits can be a very useful tool, but often the methodologies are vague and the implementation is either wrong or not explained fully enough to reproduce and analyze.
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Polovoy, Carol. "A ‘Sea Change’ in Health Care Reimbursement." ASHA Leader 17, no. 13 (October 2012): 4. http://dx.doi.org/10.1044/leader.otp.17132012.4.

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Besdine, Richard W. "Improving Health Care Quality by Reimbursement Policy." Journal of the American Geriatrics Society 46, no. 6 (June 1998): 788–90. http://dx.doi.org/10.1111/j.1532-5415.1998.tb03820.x.

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Bielitzki, Linda, and Michael A. Maffetone. "Medicare reimbursement of emerging health care technologies." Clinical Immunology Newsletter 10, no. 10 (October 1990): 154–57. http://dx.doi.org/10.1016/0197-1859(90)90044-9.

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Dissertations / Theses on the topic "Health care reimbursement"

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Cabrera, Katherine Marie. "Florida's health care reimbursement for outpatient medical nutrition therapy." FIU Digital Commons, 2002. http://digitalcommons.fiu.edu/etd/1957.

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The purpose of this study was to describe and inform registered dietitians (RDs) in the State of Florida what insurance companies are providing in terms of medical nutrition therapy (MNT) coverage. A questionnaire was developed to encompass major MNT reimbursement stipulations such as policies, specific diseases coverage, specific Current Procedural Terminology (CPT) codes and descriptors, use of the medical necessity letter and nutrition cost benefits analysis (CBA). The questionnaire, encompassing 27 plans (HMO, PPO, Indemnity, Medicare, Medicaid), also served as a MNT promotional tool for 11 top administrators from insurance companies (10 private, 1 government) around the State of Florida. The results showed that 78% of all plans reimbursed for MNT caseby- case even without specific MNT policies. Sixty-seven percent of the plans would approve for MNT reimbursement with a medical necessity letter. Half of these top administrators showed an optimistic interest in using nutrition CBAs, case studies and practice protocols for creating MNT policies. The top ranked CPT codes were found to be 99204 (1), 99202 (2), 99201 (2), 99203 (3). The most recognized corresponding descriptors with the CPT were MNT, disease management skills and training and nutritional counseling. This questionnaire may be used to create additional MNT reimbursement audits or research. The results given in this study can aid RDs in proper documentation on insurance claim forms, usage of the medical necessity letter, nutrition CBAs, practice guidelines and case studies for successful MNT reimbursement.
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Teerawattananon, Yot. "Assessing the feasibility of using economic evaluation in reimbursement of health care services in Thailand." Thesis, University of East Anglia, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.433921.

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Objective: the overall aim of this thesis is to assess the 'feasibility' of using economic evaluation for the development of health care benefit packages in Thailand, specifically for selective use on a small number of 'difficult' coverage decisions within the high-cost element of the Universal Healthcare Coverage Scheme (UC). The term 'feasibility' consists of (i) the availability of economic evaluation information for decision-making, (ii) knowledge and understanding among the users, (iii) users' perception of the benefits of economic evaluation, and (iv) the relevance of economic evaluation to the interests of different stakeholders.
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Gopinath, Puja Gopinath. "A Review of Pricing and Reimbursement for Abeona Theraputics’ Gene Therapy Products to Treat Sanfilippo Syndrome." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1497024647261096.

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Chambers, James D. "Current use and potential value of cost-effectiveness analysis in U.S. health care : the case of Medicare national coverage determinations." Thesis, Brunel University, 2012. http://bura.brunel.ac.uk/handle/2438/6521.

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There is a growing recognition that we cannot afford the provision of all new health care technologies, even those that are proven to be beneficial. This is increasingly true in the US, where health care spending is on an unsustainable upward trajectory. US health care spending is greatly in excess of that of other countries; however, with respect to key health metrics, the US health care system performs relatively poorly. Despite this, unlike many other developed countries economic evaluation, and more specifically cost effectiveness evidence, is used sparingly in the US health care system. Notably, the Centers for Medicare and Medicaid Services (CMS), administrators of the Medicare programme, state that cost-effectiveness evidence is not relevant to coverage decisions for medical technology and interventions evaluated as part of National Coverage Determinations (NCDs). The empirical aspect of this thesis evaluates the current use and potential value of using cost-effectiveness evidence in CMS NCDs. A database was built using data obtained from NCD decision memoranda, the medical literature, a Medicare claims database, and Medicare reimbursement information. The findings of the empirical work show that, CMS’s stated position notwithstanding, cost-effectiveness evidence has been cited or discussed in a number of coverage decisions, and there is a statistically significant difference between positive and non-coverage decisions with respect to cost effectiveness. When controlling for factors likely to have an effect on coverage decisions, the availability of cost-effectiveness evidence is a statistically significant predictor of coverage. In addition, the quality of the supporting clinical evidence, the availability of alternative interventions, and the recency of the decision are statistically significant variables. Further, when hypothetically reallocating resources in accordance with cost-effectiveness substantial gains in aggregate health are estimated. It is shown that using cost-effectiveness to guide resource allocation has an effect on resource allocation across patient populations and types of technology.
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Lundkvist, Jonas. "The role of economic evaluations in health care decision making /." Stockholm, 2005. http://diss.kib.ki.se/2005/91-7140-423-6/.

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Forsberg, Ewa. "Do Financial Incentives Make a Difference? : A Comparative Study of the Effects of Performance-Based Reimbursement in Swedish Health Care." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-5123-3/.

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Fowler, Erica N. Fowler. "Development of an Administrative Claims-Based Prospective Risk Tier Method for Percutaneous Coronary Intervention Episodes of Care." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1542467861407973.

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Vacková, Martina. "Finanční aspekty reformy zdravotnictví v ČR." Master's thesis, Vysoká škola ekonomická v Praze, 2011. http://www.nusl.cz/ntk/nusl-85213.

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Healthcare in the Czech Republic is currently undergoing reform changes. The aim of the thesis is to evaluate the upcoming changes in the reimbursement of health care in hospitals. To achieve the goal is used as the literature, as well as proposed legislation and the case law. The practical part of the thesis focuses on the hospitals. Emphasis is placed on the analysis of mechanisms fixed costs reimbursement of health care and reimbursement of health care by the DRG method. The potential impact of reform measures is presented on the example of an extremely costly medical care (orphan drugs). Based on the information and analysis are in the final part of the thesis describes the effects of health reform on financing health care in hospitals. At the same time also outlined a possible solution to save the cost of medical equipment in the field of medicines.
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Davidson, Carrie Jane. "Profit Status and the Relationship between Medicaid Reimbursement and Nursing Home Quality in Ohio Nursing Homes." Connect to text online, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=case1138477611.

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Thesis (Ph. D.)--Case Western Reserve University, 2006.
[School of Medicine] Department of Epidemiology and Biostatistics. Includes bibliographical references. Available online via OhioLINK's ETD Center.
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Krauchunas, Matthew. "EXAMINING CALIFORNIA’S ASSEMBLY BILL 1629 AND THE LONG-TERM CARE REIMBURSEMENT ACT: DID NURSING HOME NURSE STAFFING CHANGE?" VCU Scholars Compass, 2011. https://scholarscompass.vcu.edu/etd/2366.

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California’s elderly population over age 85 is estimated to grow 361% by the year 2050. Many of these elders are frail and highly dependent on caregivers making them more likely to need nursing home care. A 1998 United States Government Accountability Office report identified poor quality of care in California nursing homes. This report spurred multiple Assembly Bills in California designed to increase nursing home nurse staffing, change the state’s Medi-Cal reimbursement methodology, or both. The legislation culminated in Assembly Bill (AB) 1629, signed into law in September 2004, which included the Long-Term Care Reimbursement Act. This legislation changed the state’s Medi-Cal reimbursement from a prospective, flat rate to a prospective, cost-based methodology and was designed in part to increase nursing home nurse staffing. It is estimated that this methodology change moved California from the bottom 10% of Medicaid nursing home reimbursement rates nationwide to the top 25%. This study analyzed the effect of AB 1629 on a panel of 567 free-standing nursing homes that were in continuous operation between the years 2002 – 2007. Resource Dependence Theory was used to construct the conceptual framework. Ordinary least squares (OLS) and first differencing with instrumental variable estimation procedures were used to test five hypotheses concerning Medi-Cal resource dependence, bed size, competition (including assisted living facilities and home health agencies), resource munificence, and slack resources. Both a 15 and 25 mile fixed radius were used as alternative market definitions instead of counties. The OLS results supported that case-mix adjusted licensed vocational nurse (LVN) and total nurse staffing hours per resident day increased overall. Nursing homes with the highest Medi-Cal dependence increased only increased NA staffing more than nursing homes with the lowest Medi-Cal dependence post AB 1629. The fixed effects with instrumental variable estimation procedure provided marginal support that nursing homes with more home health agency competition, in a 15 mile market, had higher LVN staffing. This estimation procedure also supported that nursing homes with more slack resources (post AB 1629) increased nurse aide and total nurse staffing while nursing homes located in markets with a greater percentage of residents over the age of 85 had more nurse aide staffing.
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Books on the topic "Health care reimbursement"

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D, Minor James, ed. Legal aspects of health care reimbursement. Rockville, Md: Aspen Systems Corp., 1985.

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Schwartz, Jeffrey B. Introduction to health care reimbursement law. 4th ed. [Harrisburg, Pa.] (104 South St., P.O. Box 1027, Harrisburg 17108-1027): Pennsylvania Bar Institute, 1990.

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McKnight, Robin. Home care reimbursement, long-term care utilization, and health outcomes. Cambridge, MA: National Bureau of Economic Research, 2004.

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McKnight, Robin. Home care reimbursement, long-term care utilization, and health outcomes. Cambridge, MA: National Bureau of Economic Research, 2004.

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Rosen, Bruce. A mapping of health care reimbursement in Israel. Jerusalem: JDC--Brookdale Institute of Gerontology and Adult Human Development, 1988.

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New York (State). Governor's Health Care Advisory Board. Committee on Finance and Reimbursement. Policy proposal: Ambulatory care reimbursement reform. [Albany, N.Y.?: Governor's Health Care Advisory Board, 1993.

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Horowitz, Marcia. Health care management. New York: Ferguson Pub., 2010.

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Coding and reimbursement: The complete picture within health care. Chicago: AHA Press, 1999.

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James, Ella. Documentation and reimbursement for long-term care. 2nd ed. Chicago, Ill: American Health Information Management Association, 2009.

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American Health Information Management Association., ed. Documentation and reimbursement for long-term care. Chicago, Ill: American Health Information Management Association, 2004.

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Book chapters on the topic "Health care reimbursement"

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Merrill, Jeffrey C. "Cost Containment and Reimbursement." In The Road to Health Care Reform, 185–262. Boston, MA: Springer US, 1994. http://dx.doi.org/10.1007/978-1-4899-5994-2_7.

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Heath, Cathryn B. "Coding, Billing, and Reimbursement for Procedures." In Primary Care Procedures in Women's Health, 7–11. New York, NY: Springer New York, 2010. http://dx.doi.org/10.1007/978-0-387-76604-1_2.

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Heath, Cathryn B. "Coding, Billing, and Reimbursement for Procedures." In Primary Care Procedures in Women's Health, 7–11. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-28884-6_2.

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Jain, Sachin H., and Elaine Besancon. "Reimbursement: Understanding How We Pay for Health Care." In An Introduction to Health Policy, 179–87. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-7735-8_15.

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Zuvekas, Samuel H. "Financing of Behavioral Health Services: Insurance, Managed Care, and Reimbursement." In Foundations of Behavioral Health, 71–99. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-18435-3_4.

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Ticona, Luis. "Health-Care Reform and Its Impact in Medical Reimbursement." In Utilization Management in the Clinical Laboratory and Other Ancillary Services, 1–5. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-34199-6_1.

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Sivakumar, Haran, Megan Alexander, Allison Theberge, and Deepa Sannidhi. "Models of Care for Women and Families, Reimbursement, and Telemedicine." In Improving Women's Health Across the Lifespan, 145–53. New York: CRC Press, 2021. http://dx.doi.org/10.1201/9781003110682-8.

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Wong-Rieger, Durhane, and Francis Rieger. "Health Policies for Orphan Diseases: International Comparison of Regulatory, Reimbursement and Health Services Policies." In Communications in Medical and Care Compunetics, 267–77. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-38643-5_27.

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Rauner, Marion S., and Michaela M. Schaffhauser-Linzatti. "Impact of Inpatient Reimbursement Systems on Hospital Performance: The Austrian Case-Based Payment Strategy." In Operations Research and Health Care Policy, 129–53. New York, NY: Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-6507-2_7.

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Norris, Margaret. "Policies and Reimbursement: Meeting the Need for Mental Health Care in Long-Term Care." In Geropsychology and Long Term Care, 1–11. New York, NY: Springer US, 2008. http://dx.doi.org/10.1007/978-0-387-72648-9_1.

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Conference papers on the topic "Health care reimbursement"

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Ariwardani, Betty Nurizky, Didik Gunawan Tamtomo, and Bhisma Murti. "Path Analysis on the Determinants of Hospital Lost Under INA-CBGS Reimbursement for Patient with Dengue Hemorrhagic Fever in Ngawi Regional Public Hospital, East Java." In The 7th International Conference on Public Health 2020. Masters Program in Public Health, Universitas Sebelas Maret, 2020. http://dx.doi.org/10.26911/the7thicph.04.35.

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ABSTRACT Background: Hospitals are demanded to be more efficient and effective in providing medical services to avoid losses in the era of National Health Insurance. The increase in cases of dengue hemorrhagic fever (DHF) is a burden on the cost of medical services in Indonesia. This study aimed to examine the determinants of hospital lost under Indonesia Case-Based Groups (INA-CBGs) reimbursement for patients with dengue hemorrhagic fever (DHF). Subjects and Method: A cross-sectional study was carried out at dr. Soeroto hospital, Ngawi, East Java, from September to October 2019. A sample of 200 in-patients was selected by simple random sampling. The dependent variable was tariff difference between INA-CBGs and hospital cost. The independent variables were class of treatment, length of stay, blood transfusion, co-morbidity, and complication. The data were obtained from DHF in-patients’ medical record. The data were analyzed by path analysis model run on Stata 13. Results: Tariff difference was directly and positively affected by length of stay (b= 2.77; 95% CI= 1.78 to 3.75; p<0.001), blood transfusion (b= 2.95; 95% CI= 0.36 to 5.54; p= 0.025), patients age (b= 0.09; 95% CI= -1.52 to 1.71; p= 0.907), co-morbidity (b= 0.58; 95% CI= -1.07 to 2.22; p= 0.491), and complication (b= 0.34; 95% CI= -1.69 to 2.36; p= 0.743). Tariff difference was directly and negatively affected by type of treatment (b= -0.81; 95% CI= -2.02 to 0.40; p= 0.191). Tariff difference was indirectly affected by co-morbidity, complication, class of treatment, and patient age. Conclusion: Tariff difference is directly and positively affected by length of stay, blood transfusion, patient age, co-morbidity, and complication. Tariff difference is directly and negatively affected by type of treatment. Tariff difference is indirectly affected by co-morbidity, complication, class of treatment, and patient age. Keywords: INA CBGs, hospital tariff, care cost, dengue hemorrhagic fever Correspondence: Betty Nurizky Ariwardani. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Email: bettyna175@-gmail.com. Mobile: 082233243164. DOI: https://doi.org/10.26911/the7thicph.04.35
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Reports on the topic "Health care reimbursement"

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McKnight, Robin. Home Care Reimbursement, Long-term Care Utilization, and Health Outcomes. Cambridge, MA: National Bureau of Economic Research, April 2004. http://dx.doi.org/10.3386/w10414.

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Maclean, Johanna Catherine, Chandler McClellan, Michael Pesko, and Daniel Polsky. Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health. Cambridge, MA: National Bureau of Economic Research, July 2018. http://dx.doi.org/10.3386/w24805.

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Gruber, Jonathan, Nathaniel Hendren, and Robert Townsend. Demand and Reimbursement Effects of Healthcare Reform: Health Care Utilization and Infant Mortality in Thailand. Cambridge, MA: National Bureau of Economic Research, January 2012. http://dx.doi.org/10.3386/w17739.

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Gillen, Emily, Olivia Berzin, Adam Vincent, and Doug Johnston. Certified Electronic Health Record Technology Under the Quality Payment Program. RTI Press, January 2018. http://dx.doi.org/10.3768/rtipress.2018.pb.0014.1801.

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The 2016 Quality Payment Program (QPP) is a Medicare reimbursement reform designed to incentivize value-based care over volume-based care. A core tenet of the QPP is integrated utilization of certified electronic health record technology (CEHRT). Adopting and implementing CEHRT is a resource-intensive process, requiring both financial capital and human capital (in the form of knowledge and time). Adoption can be especially challenging for small or rural practices that may not have access to such capital. In this issue brief, we discuss the role of CEHRT in the QPP and offer policy recommendations to help small and rural practices improve their health information technology (IT) capabilities with regards to participation in value-based care. The QPP requires practices to have health IT capabilities, both as a requirement for a complete performance score and to facilitate reporting. Practices that are unable to implement CEHRT will have difficulty complying with the new reimbursement system, and will likely incur financial losses. We recommend monetary support and staff training to small and rural practices for the adoption of CEHRT, and we recommend assistance to help practices comply with the requirements of the QPP and coordinate with other small and rural practices for reporting purposes.
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