BACKGROUND The current economic environment necessitates efforts to prevent avoidable losses in clinical revenue in academic cardiothoracic surgery programs. Inadequate documentation frequently results in delayed, denied, or reduced reimbursement. With the recent increase in integrated residency programs, documentation and compliance are becoming increasingly dependent on junior residents; howe...

Children's hospitals were excluded indefinitely from the prospective payment system until a methodology for their reimbursement could be developed. Special consideration in reimbursement policy could be made for children's hospitals if their patients were generally more resource intensive than the pediatric patients of other hospitals. The resource intensity of patients in children's hospitals ...

Medicare and Medicaid originally paid for hospital services using a “cost plus” reimbursement basis, where hospitals were paid for all of their costs and more. Under this reimbursement system, hospital profits were directly linked with patient volumes. While the basis of the argument for this set of circumstances, i.e. “supply creating demand,” may have been valid during the “cost-plus reimburs...

Background A reimbursement policy for angiotensin-converting enzyme (ACE) inhibitors based only on controlling expenditure and not adequate for the patient access to treatment could not return expected results for longterm improvement of patients’ health. The study addresses the need for optimization of the reimbursement policy of the National Health Insurance Fund in Bulgaria (NHIF) which is b...

It's often a balancing act to determine if patients should be admitted to the hospital or receive observation services as an outpatient, but it's critical to get it right the first time so the hospital will get appropriate reimbursement and avoid having money taken away following audits. Reimbursement is much lower for observation services, but if a patient is admitted inappropriately, Medicare...

INTRODUCTION Higher-level-of-care (HLOC) transfers to tertiary care hospitals are common. While this has been shown profitable for hospitals, the impact on physicians has not been described. Community medical center call panels continue to erode, in part due to the perception that patients needing transfer are underinsured. Surveys show that the problematic specialties to maintain call panels i...

The current patient classification schemes used in case-mix reimbursement are not fully sensitive to variations in resource consumption that are associated with differential disease severity. Disease staging is a clinically based measure of severity that uses objective medical criteria to assess the stage of disease progression. Its availability in automated form increases its ease of implement...