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References: Healthcare Revenue and Cost Analysis

  1. Revenue Cycle Management - Wikipedia - Explains the end-to-end process of tracking patient revenue from scheduling through final payment, the umbrella process this chapter models as a graph connecting charge capture, coding, and collection.

  2. Chargemaster - Wikipedia - Describes the comprehensive, provider-maintained price list for billable services that this chapter models as a ChargeMasterItem node mapping to billing codes and revenue categories.

  3. Capitation (healthcare) - Wikipedia - Covers the fixed per-member-per-month payment arrangement central to this chapter's discussion of provider compensation, risk adjustment, and incentives toward preventive care.

  4. Essentials of Health Care Finance (9th Edition) - William O. Cleverley, James O. Cleverley, and Paula H. Song - Jones & Bartlett Learning - Long recognized as the leading healthcare finance textbook for its clear treatment of cost concepts, product costing, and departmental cost allocation, directly mirroring this chapter's cost-of-care and profitability worked examples.

  5. Health Care Economics (7th Edition) - Paul J. Feldstein - Cengage/Delmar Learning - The standard graduate health-economics textbook credited for its distinctive analysis of how payer mix and reimbursement method shape provider incentives, the exact mechanism this chapter uses to explain payer-mix-driven profitability.

  6. Basics of Value-Based Care - Centers for Medicare & Medicaid Services - CMS's own plain-language introduction to value-based care, the payment philosophy this chapter presents as the umbrella goal that quality metrics and risk-adjusted capitation are built to support.

  7. Healthcare Revenue Cycle Management (RCM) - What It Is & How It Works - Healthcare Financial Management Association - An industry-standard explainer of the revenue cycle's stages, from registration through denial processing, matching this chapter's framing of the revenue cycle as the umbrella process connecting claims, coding, and collection.

  8. How Does Health Spending in the U.S. Compare to Other Countries? - Peterson-KFF Health System Tracker - Provides the per-person and GDP-share spending comparisons across peer nations that this chapter cites to show U.S. healthcare costs are driven by price rather than utilization.

  9. How Physician Compensation Models Work: Salary, wRVU, Hybrid and Value-Based Plans Compared - Medical Group Management Association - A practitioner-oriented breakdown of wRVU, salary, and hybrid compensation structures that underlies this chapter's comparison of fee-for-service versus capitation-based provider pay.

  10. Understanding the CMS Hierarchical Condition Category (HCC) Coding Model - AGS Health - Walks through how HCC risk scores are calculated and applied to per-member-per-month payments, directly explaining the risk-adjustment mechanics behind this chapter's capitation worked example.