Unpublished Paper
Revenue-Cycle Management and Reimbursement: The Impact of Health Law and Health Reform on Providers
(2011)
  • Timothy D Martin , Southern Methodist University
Abstract

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 have on payment systems and providers’ legal rights and obligations.

Keywords
  • Revenue-Cycle Management,
  • RCM,
  • Reimbursement,
  • Preferred-Provider Organization,
  • PPO,
  • Silent PPO,
  • Health-Maintenance Organization,
  • HMO,
  • Managed-Care Organization,
  • MCO,
  • CMS,
  • Diagnosis-Related Group,
  • DRG,
  • MS-DRG,
  • AP-DRG,
  • APR-DRG,
  • Ambulatory Payment Classification,
  • APC,
  • ICD,
  • ICD-9,
  • ICD-10,
  • HCPCS,
  • CPT,
  • IME,
  • DGME,
  • DSH,
  • Outlier,
  • Per Diem,
  • Patient Protection and Affordable Care Act,
  • PPACA,
  • False Claims Act,
  • FCA,
  • HITECH Act,
  • FERA,
  • Evidence-Based Medicine,
  • EBM,
  • Value-Based Purchasing,
  • VBP,
  • Value-Based Insurance Design,
  • VBID,
  • Clean Claim,
  • Prompt Pay,
  • Coordination of Benefits,
  • COB,
  • Value Code,
  • Bill Tyle Code,
  • Charge Code,
  • Charge Description Master,
  • CDM,
  • Revenue Code,
  • Value Code,
  • Condition Code,
  • Upcoding,
  • Unbindling,
  • Bundled Payment,
  • Bundling,
  • Fee for Service Resource-Based Relative Value Scale,
  • RBRVS,
  • UB-04,
  • CMS-1500
Publication Date
2011
Citation Information
Timothy D Martin. "Revenue-Cycle Management and Reimbursement: The Impact of Health Law and Health Reform on Providers" (2011)
Available at: http://works.bepress.com/timothy_martin/4/