Synopses & Reviews
Understanding Health Insurance: A Guide to Professional Billing, 7th edition, is a comprehensive guide for those learning about health insurance claims processing and reimbursement issues. The text utilizes a step-by-step approach to successful completion of health insurance claims. The objectives of this edition are to 1) introduce information about major third party payers, 2) provide up-to-date information about federal health care regulations, 3) clarify coding guidelines and provide application exercises for each coding system, 4) introduce reimbursement issues, 5) emphasize the importance of coding for medical necessity, and 6) help users develop the skill to complete claims accurately. Numerous examples help clarify key concepts. Case studies and review exercises provide users with numerous opportunities to apply knowledge and develop skills incompleting CMS-1500 claims accurately. The textbook CD-ROM and accompanying workbook provide additional exercises and practice in completing CMS-1500 claims electronically. Current information is provided on CPT-5 and ICD-10-CM coding systems. The appendices include information about processing UB-92 (CMS-1450) claims and dental claims.
Synopsis
Understanding Health Insurance is a comprehensive guide for those learning about health insurance claim processing. Objectives of this edition are 1) to introduce information about major insurance programs and federal health care legislation, 2) to provide basic information on national diagnosis and procedure coding systems and 3) simplify the process of completing claim forms. Contains pertinent, easy-to-understand information on common health insurance plans, with separate chapters on coding and reimbursement issues, and step-by-step instructions for HCFA-1500 claim completion. Case studies and review exercises give users numerous opportunities to apply knowledge to build skill in completing HCFA-1500 claims accurately. CD-ROM in text and accompanying workbook provides additional exercises and practice in completing HCFA-1500 claims electronically. Includes new information regarding CPT-5, ICD-10-CM and HCFA reimbursement issues. Also available are Web Tutor and Blackboard versions.
About the Author
Founder and Former Chairperson, Medical Assisting Department
Anne Arundel Community College, Arnold, MDMichelle A. Green is a SUNY Distinguished Teaching Professor at Alfred State College in Alfred, New York. She is an active member of the American Academy of Professional Coders (AAPC) and the American Health Information Management Association (AHIMA). She has won many awards in recognition of her teaching excellence, including the State University of New York Chancellor's Award for Excellence in Teaching, Alfred State College Alumni Association Teacher of the Year, and Who's Who Among America's Teachers. Ms. Green holds an MPS, is a Registered Health Information Administrator (RHIA), a Fellow of the American Health Information Management Association (FAHIMA) and a Certified Medical Coder (CPC).
Table of Contents
Preface, Chapter 1 - Health Insurance Specialist?Roles and Responsibilities, Chapter 2 - Introduction to Health Insurance, Chapter 3 - Managed Health Care, Chapter 4 - Life Cycle of an Insurance Claim, Chapter 5 - Legal and Regulatory Considerations, Chapter 6 - ICD-9-CM Coding, Chapter 7 - CPT Coding, Chapter 8 - HCPCS Coding (name change from HCPCS Coding System), Chapter 9 - CMS Reimbursement Issues (name change from HCFA Reimbursement Issues), Chapter 10 - Coding for Medical Necessity (name change from Coding from Source Documents), Chapter 11 - Essential Claims Completion Guidelines (name change from Essential Claim Form Instructions), Chapter 12 - Commercial Claims (name change from Filing Commercial Claims), Chapter 13 - Blue Cross and Blue Shield Plans, Chapter 14 - Medicare, Chapter 15 - Medicaid, Chapter 16 - TRICARE, Chapter 17 - Workers' Compensation, Appendix I - Case Studies: Set One, Appendix II - Clinic Billing Manual and Case Studies: Set Two, Appendix III - Forms, Appendix IV - Answers to Coding Exercises, Appendix V - Using the UHI Student Practice CD-ROM, Appendix VI - Abbreviations, Appendix VII - Common Medical Terminology Prefixes, Suffixes, and Combining Forms, Appendix VIII - Web Sites, Appendix IX -X - Electronic Data Interchange and the UB-92 (CMS-1450), Appendix X - Dental Claims ProcessingInsurance, Appendix XI - Bibliography, Appendix XII - Glossary