AHLA Medicare Law (Cornerstone Series) (AHLA Members)
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The American Health Law Association is pleased to bring you the Third Edition of Medicare Law. Our tremendous thanks go to Editor-in-Chief Thomas W. Coons and author experts Rodney A. Johnson, Emily Jane Cook, John R. Hellow, David W. Hilgers, Elizabeth T. Thomas, Matthew Philip Utecht, Kathleen Ann Peterson, Anne W. Hance, Gary Scott Davis, Adam J. Rogers, Donald H. Romano, Robert L. Roth, William T. Mathias, and James F. Flynn. Their work, like that of the previous author Terry Coleman, leads you through the Medicare maze, from a discussion about the program's structure, to the critically important aspects of benefits, coverage, and eligibility.
Coverage includes in depth examination and discussion of:
- Payment for hospital services, including PPS and PPS-exempt hospitals
- Hospital payment methods
- The DRG system
- The urban/rural distinctions
- Outlier payments
- The physician fee schedule
- Cost reimbursement
- Prohibited acts under the Anti-Kickback and Stark Laws
- Administrative and judicial appeals processes; and
- The new incentive payment programs
This is the road map to a thorough understanding of Medicare, whether you are just beginning the journey or are continuing to learn about this complex and important aspect of healthcare law. Best of all, it is organized to facilitate an understanding of the program and provides citations to the underlying portions of the statute, regulations and manuals.
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Published December, 2012.
Table of Contents
About the American Health Law Association
Recent Titles from Health Lawyers
About the Editor-in-Chief
About the Authors
Chapter 1 — Introduction
Chapter 2 — Benefits and Coverage Under Part A and Part B
Chapter 3 — Payment for Hospital Services
Chapter 4 — Payment for Physician Services
Chapter 5 — Payment for Other Items and Services
Chapter 6 — Prescription Drug Benefit
Chapter 7 — Medicare Advantage and PACE Plans
Chapter 8 — Cost Reimbursement
Chapter 9 — Conditions for Coverage and Payment
Chapter 10 — Billing, Payment, and Charges
Chapter 11 — Prohibited Acts and Penalties
Chapter 12 — Appeals and Reopenings
Chapter 13 — Incentive Payment Programs