About the Book

Hospital Reimbursement: Concepts and PrinciplesDue to the countless variables that affect revenue and cost, the hospital reimbursement process is by far the most complex of any industry. Requiring only a basic financial background and a working knowledge of accounting, Hospital Reimbursement: Concepts and Principles supplies a clear understanding of the concepts and principles that drive the revenue cycle within a hospital setting.


The book explains the technical aspects of reimbursement in language that is easy to comprehend. It illustrates the complexities of the hospital revenue cycle and explains the Medicare and Medicaid financial models in detail. The text also addresses the Medicaid reimbursement methodology, the formulation of the Medicare blend rate, the computation of both DSH and IME, as well as other third-party payers. It also:

  • Covers the full range of services and procedures for which a hospital can receive reimbursement

  • Explains the difference between a for-profit and not-for-profit hospital

  • Contains chapters devoted to Statements of Operations (Income Statement) and Statements of Financial Operations (Balance Sheet)

  • Examines governmental cost reporting – including Worksheets A, A-6, A-8, A-8-2, B-1, B Part 1, C Part 1, D-3, D-5 and E Part A

Supplying readers with a foundation in coding principles, the text also includes a model for calculating the financial impact of variations in patient length of stay. It discusses the DRG and APC reimbursement models and details the computation of an outlier payment. In addition, it walks the reader step-by-step through the creation of a mock Medicare cost report for a sample hospital.


About the Author

Kyle Herbert
Kyle Herbert

You can contact the author at kyle.herbert@cpa.com.

The text can be purchased at www.crcpress.com, www.amazon.com or other sites that sell books.




Experience

Over fourteen years experience in hospital accounting and reimbursement within three different healthcare systems.


Education
  • CPA - Certified Public Accountant, State of South Carolina
  • CMA - Certified Management Accountant, Institute of Management Accountants
  • FHFMA - Fellowship with Healthcare Financial Management Association
  • FACHE - Fellowship with American College of Healthcare Executives
  • MBA - Masters Degree in Business Administration, The Citadel
  • B.S. in Finance - University of Richmond


Academic Appointments

  • Adjunct Professor, University of South Carolina, Arnold School of Public Health, Master's Degree in Healthcare Administration Program

Awards

  • American College of Healthcare Executives, FYE 2012 "Early Career" Healthcare Executive of the Year Award
  • Fulbright Scholar, Specialist Program, Chulalongkorn University, Bangkok, Thailand (Dec 13 - Jan 14)

Organizations/Affiliations
  • South Carolina Association of CPA’s
  • American Institute of CPA's (AICPA)
  • Institute of Management Accountants (IMA)
  • Health Care Financial Management Association (HFMA)
  • American College of Healthcare Executives (ACHE)
 
Charitable Work
  • Created the Bright Future Scholarship for Foster Care Children which is a public charity that provides partial academic scholarships to foster care children within the State of South Carolina.