Synopses & Reviews
Book w/ CD-Rom.
Understanding Health Insurance: A Guide to Professional Billing,, 7th Edition, is a comprehensive guide for those learning about health insurance cleaims 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 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 remibursement 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 in completing 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.
Features
- For each major payer, the text "walks" users through the steps of completing insurance claims.
- A "one-stop-shop" approach integrates diagnosis and procedure coding, reimbursement and legal issues, and health insurance claims processing.
- Each insurance payer chapter contains case studies for CMS-1500 completion. Additional case studies for claim completion are provided in the appendices.
- New patient encounter form for all CMS-1500 completion exercises and case studies simplifies extracting information.
- The student CD-ROM at the back of the text contains case studies for practice in claim form electronic data entry.
- Appendices include instructions for completing the UB-92 (CMS-1450) form.
Synopsis
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 in completing 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: 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 in completing 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: A Guide to Billing and Reimbursement, 8th Edition is a comprehensive source for teaching the subject of health insurance and reimbursement. The book contains chapters on introductory information on the health insurance field, managed health care, legal and regulatory issues, coding systems, reimbursement methodologies, coding for medical necessity, and common health insurance plans. Each chapter contains exercises to illustrate content and reinforce learning. Numerous opportunities are provided throughout the book for manual completion of CMS-1500 claims. A CD-ROM at the back of the book allows for electronic data entry of CMS-1500 claim form information. End of chapter review questions in objective format (e.g., multiple choice) test learners on their understanding of book content. Appendices I and II provide case studies that are also included on the Student Practice CD-ROM. Additional appendices provide instruction in dental claims processing and completion of the UB-92 (claim used for inpatient and outpatient hospital claims). The accompanying workbook provides application based assignments for each chapter, additional content review (multiple choice questions), and additional case studies for practice in completing CMS-1500 claims. This edition of the book contains the most up to date information regarding health insurance claims processing and coding and reimbursement issues.\''
Synopsis
Understanding Health Insurance: A Guide to Billing and Reimbursement, 8th Edition is a comprehensive source for teaching the subject of health insurance and reimbursement. The book contains chapters on introductory information on the health insurance field, managed health care, legal and regulatory issues, coding systems, reimbursement methodologies, coding for medical necessity, and common health insurance plans. Each chapter contains exercises to illustrate content and reinforce learning. Numerous opportunities are provided throughout the book for manual completion of CMS-1500 claims. A CD-ROM at the back of the book allows for electronic data entry of CMS-1500 claim form information. End of chapter review questions in objective format (e.g., multiple choice) test learners on their understanding of book content. Appendices I and II provide case studies that are also included on the Student Practice CD-ROM. Additional appendices provide instruction in dental claims processing and completion of the UB-92 (claim used for inpatient and outpatient hospital claims). The accompanying workbook provides application based assignments for each chapter, additional content review (multiple choice questions), and additional case studies for practice in completing CMS-1500 claims. This edition of the book contains the most up to date information regarding health insurance claims processing and coding and reimbursement issues.
Synopsis
nderstanding 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
About the Author
Founder and Former Chairperson, Medical Assisting Department
Anne Arundel Community College, Arnold, MDProfessor, PhysicalandLife Sciences Department, Alfred State College, Alfred, NY.
Recipient, State University of New York Chancellor?s Award for Excellence in Teaching, 2000. Who?s Who Among America?s Teachers, 1994 and 1999. Active member, American Academy of Professional Coders, American Association of Medical Assistants, American Health Information Management Association, National Cancer Registrars Association, and state and local affiliates.
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