Synopses & Reviews
Glencoe Medical Insurance provides focused coverage of the knowledge and skills necessary for successful medical insurance processing, including in-depth coverage of medical insurance, the claims process, HCFA 1500, and UB-92. It covers all types of medical insurance including Blue Cross, Blue Shield, HMOs, PPOs, Medicare, Medicaid, and other plans. Managed care is integrated throughout the text, including discussion of contract law as it relates to managed care. There is an emphasis on practice management and patient finance. Optional exploratory computer activities use MediSoft for Windows Advanced. The focus in the text is on electronic claims filing but paper claims are covered as well. Unique to this text is an entire chapter emphasizing how crucial correct coding is to reimbursement and compliance with federal regulations.
Synopsis
Designed for the one-semester medical insurance course, Medical Insurance provides clear, focused, and authoritative instruction on medical insurance and reimbursement, with an emphasis on electronic processing. All types of medical insurance are covered, and examples in the text represent a realistic mix of managed care and fee-based plans. The program teaches basic medical coding and coding compliance, because this knowledge is essential for ensuring maximum appropriate reimbursement for reported healthcare services. A new chapter on HIPAA features the rules on transactions and code with detailed coverage of claim transmission and remittance advice.
Description
Includes bibliographical references (p. 539-540) and index.
Table of Contents
Part 1: The Health Care Environment
Chapter 1 Introduction to Managed Care and Medical Insurance
Chapter 2 Introduction to Claims Processing
Chapter 3 The Legal Environment
Part 2: Physician Coding Guidelines
Chapter 4 Diagnostic Coding: Introduction to ICD-9-CM
Chapter 5 Procedural Coding: Introduction to CPT-4 and HCPCS
Chapter 6 Coding Linkage and Compliance
Part 3: Claims Processing
Chapter 7 Provider Charges and Payment Methods
Chapter 8 The Universal Health Insurance Claim Form: HCFA-1500
Chapter 9 Claim Adjudication, Reimbursement Follow-Up, and Record
Part 4: Health Care Payers
Chapter 10 Managed Care Contracts and Private Payers
Chapter 11 Medicare
Chapter 12 Medicaid
Chapter 13 TRICARE and CHAMPVA
Chapter 14 Blue Cross and Blue Shield
Chapter 15 Workers: Compensation and Disability
Chapter 16 Hospital Billing: The UB-92 Claim Form