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Financial Professional's Guide to Healthcare Reform

ISBN-10: 1118093224

ISBN-13: 9781118093221

Edition: 2012

Authors: Mark O. Dietrich, Gregory D. Anderson

List price: $75.00
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Description:

A comprehensive reference guide interpreting and applying healthcare reform law for consultants, appraisers, accountants, and attorneysThe Financial Consultants′Guide to Healthcare Reform provides an historical backdrop on how the healthcare system got to its present state including the Massachusetts Reform and Medicare Advantage along with an explanation of the principal types of health insurance in the United States and how "insurance" actually works. A review and explanation of each of the reform provisions follows, including an analysis of what the implications are for providers, consumers and business and what responses each of these communities might have to the Reform. Using the authors′ insights and firsthand experiences in U.S. healthcare finance, this book explains the new healthcare law for individuals and businesses alike, what to expect from it and what actions they need to take to comply.Interprets and applies the health care reform lawProvides examples of what the impact of the law might look likeExtensive use of sidebars to provide in–depth analysis or background on particular topics of import, where the reader may need more detail to understand the context of Reform′s changes.Written for consultants, appraisers, accountants, and attorneysWritten by major figures in the world of healthcare valuation and consultingThe Financial Consultants′ Guide to Healthcare Reform provides a complete handbook to healthcare reform for financial consultants, both for understanding this important legislation as well as for planning responses to it.
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Book details

List price: $75.00
Copyright year: 2012
Publisher: John Wiley & Sons, Limited
Publication date: 6/12/2012
Binding: Hardcover
Pages: 406
Size: 7.50" wide x 10.25" long x 1.50" tall
Weight: 1.980
Language: English

Foreword
Preface
Acknowledgments
Introduction
A Brief Recap of the History of Reform
Early Reform Efforts
Tax Deductibility of Health Insurance
The Great Society: Medicare and Medicaid
The 1970s: Medicare HMOs and ERISA
Regulation: The Anti-Kickback Statute
Prospective Payment Systems
The 1990s
Rise of Managed Care
The Stark Law: Anti-Referral Statute
Balanced Budget Act of 1997
Balanced Budget Revision Act and Benefits Improvement and Protection Act
Failure of Managed Care
Provider Integration and Consolidation
Summary of the Healthcare Market in 2000
The New Century
One Size Fits All? Geographic Disparities in the U.S. Healthcare System
Profit and Nonprofit Hospitals and Health Insurers
History of Blue Plans
Medicare: The Other White Meat
Other Market-Based Studies
Geo-Clinical Differences
Summary
Massachusetts
The Time Line of Massachusetts Reform
Early Reform Legislation in Massachusetts
Acts of 1996
Targeting the Small Group Market
Targeting the Trade Associations Offering Health Insurance to their Members
The Intervening Years
Components of the 2006 Massachusetts Legislation
Merging the Small Group and Individual Markets
Commonwealth Care Subsidies
Key Features of Massachusetts Reform
Recounting the Results of Reform in Massachusetts
Universal Coverage
Response of the Healthcare Provider Community
Differing Views of Massachusetts Reform
Special Commission on the Health Care Payment System
The Alternative Quality Contract
State Government Reports Tracking the Results of Reform
The Small Group and Individual Market versus Self-Insured Market
Massachusetts Quarterly Reports
Massachusetts Attorney General�s Report
Similar Experience in Other Markets
Specific Comparisons
Take from the Poor and Give to the Rich?
Impact on Market Share of Financially Weaker Providers
Most Favored Nation Clauses
Tiered Pricing
Recent Legislative Changes through August 2010
Open Hearings in December 2009
August 2010 Changes in Massachusetts
Open Enrollment
Review of Premium Increases
Tiered Network Requirement
What CanWe Learn from the Massachusetts Experience?
Insurance Reforms
What is Insurance?
Components of Health Insurance and Healthcare Entitlement
Sources of Coverage
Medicare
Medicaid
Self-Insured Employers
Small Group (Small Business) Insureds
Individual Insureds
Large Group�Business Not Self-Insuring
Selected Legislative Text for Insurance Exchanges
CMS Proposed Regulations�Glossary of Health Insurance and Medical Terms
Using the Massachusetts Health Connector
Medicare Advantage Plans
PPACA Sections Affecting Medicare Advantage
Table of Medicaid Provisions in the PPACA
Subtitle D�Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans
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