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eBook Details:
Full title: Understanding Health Insurance: A Guide to Billing and Reimbursement – 2020, 15th Edition
Edition: 15th
Copyright year: 2021
Publisher: Cengage Learning
Author: Michelle Green
ISBN: 9780357478165, 9780357478172
Format: PDF
Description of Understanding Health Insurance: A Guide to Billing and Reimbursement – 2020, 15th Edition:
Prepare for a successful career in medical billing and insurance processing or revenue management with the help of Green’s UNDERSTANDING HEALTH INSURANCE: A GUIDE TO BILLING AND REIMBURSEMENT, 2020 Edition. This comprehensive, inviting book presents the latest medical code sets and coding guidelines as you learn to complete health plan claims and master revenue management concepts. This edition focuses on today’s most important topics, including managed care, legal and regulatory issues, coding systems and compliance, reimbursement methods, clinical documentation improvement, coding for medical necessity, and common health insurance plans. Updates introduce new legislation that impacts health care. You also examine the impact on ICD-10-CM, CPT, and HCPCS level II coding; revenue cycle management; and individual health plans.Important Notice: Media content referenced within the product description or the product text may not be available in the ebook version.
Table of Contents of Understanding Health Insurance: A Guide to Billing and Reimbursement – 2020, 15th Edition PDF ebook:
Table of ContentsPrefaceAbout the AuthorReviewersAcknowledgmentsHow to Use This TextHow to Use SimClaim CMS-1500 SoftwareChapter 1: Health Insurance Specialist CareerChapter OutlineChapter ObjectivesKey TermsIntroductionHealth Insurance OverviewCareer OpportunitiesEducation and TrainingJob ResponsibilitiesIndependent Contractor and Employer LiabilityProfessionalismProfessional Associations and CredentialsSummaryInternet LinksReviewChapter 2: Introduction to Health InsuranceChapter OutlineChapter ObjectivesKey TermsIntroductionIntroduction to Health InsuranceMajor Developments in Health InsuranceHealth Care DocumentationElectronic Health Record (EHR)SummaryInternet LinksReviewChapter 3: Managed Health CareChapter OutlineChapter ObjectivesKey TermsIntroductionHistory of Managed CareManaged CareManaged Care ModelsConsumer-Directed Health PlansAccreditation of Managed Care OrganizationsEffects of Managed Care on a Physician’s PracticeSummaryInternet LinksReviewChapter 4: Revenue Cycle ManagementChapter OutlineObjectivesKey TermsIntroductionRevenue Cycle ManagementEncounter Form and ChargemasterProcessing an Insurance ClaimManaging PatientsManaging Office Insurance FinancesInsurance Claim CycleMaintaining Insurance Claim FilesCredit and CollectionsSummaryInternet LinksReviewChapter 5: Legal Aspects of Health Insurance and ReimbursementChapter OutlineChapter ObjectivesKey TermsIntroductionOverview of Laws and RegulationsFederal Laws and Events That Affect Health CareRetention of RecordsHealth Care Audit and Compliance ProgramsHealth Insurance Portability and Accountability Act (HIPAA)SummaryInternet LinksReviewChapter 6: ICD-10-CM CodingChapter OutlineChapter ObjectivesKey TermsIntroductionGeneral Equivalence MappingsOverview of ICD-10-CM and ICD-10-PCSICD-10-CM Coding ConventionsICD-10-CM Index and Tabular ListOfficial Guidelines for Coding and ReportingSummaryInternet LinksReviewChapter 7: CPT CodingChapter OutlineChapter ObjectivesKey TermsIntroductionOrganization of CPTCPT IndexCPT ModifiersEvaluation and Management SectionAnesthesia SectionSurgery SectionRadiology SectionPathology and Laboratory SectionMedicine SectionCPT Category II and Category III CodesSummaryInternet LinksReviewChapter 8: HCPCS Level II CodingChapter OutlineChapter ObjectivesKey TermsIntroductionPurpose of HCPCS Level II CodesOrganization of HCPCS Level II CodesDocumentation and Submission Requirements for Reporting HCPCS Level II CodesAssigning HCPCS Level II Codes and ModifiersSummaryInternet LinksReviewChapter 9: CMS Reimbursement MethodologiesChapter OutlineChapter ObjectivesKey TermsIntroductionCMS ReimbursementCMS Fee SchedulesCMS Payment SystemsSummaryInternet LinksReviewChapter 10: Coding Compliance Programs, Clinical Documentation Improvement, and Coding for Medical NChapter OutlineChapter ObjectivesKey TermsIntroductionCoding Compliance ProgramsClinical Documentation ImprovementCoding for Medical NecessityCoding from Case Scenarios and Patient RecordsSummaryInternet LinksReviewChapter 11: CMS-1500 and UB-04 ClaimsChapter OutlineChapter ObjectivesKey TermsIntroductionGeneral Claims InformationCMS-1500 Data EntryProcessing Secondary CMS-1500 ClaimsCommon Errors That Delay CMS-1500 Claims ProcessingFinal Steps in Processing CMS-1500 ClaimsMaintaining CMS-1500 Insurance Claim Files for the Medical PracticeUB-04 ClaimSummaryInternet LinksReviewChapter 12: Commercial InsuranceChapter OutlineChapter ObjectivesKey TermsIntroductionCommercial Health InsuranceAutomobile, Disability, and Liability InsuranceCommercial Claims InstructionsCommercial Secondary Coverage Claims InstructionsCommercial Group Health Plan Coverage Claims InstructionsSummaryInternet LinksReviewChapter 13: BlueCross BlueShieldChapter OutlineChapter ObjectivesKey TermsIntroductionBlueCross BlueShieldBlueCross BlueShield PlansBlueCross BlueShield Billing NotesBlueCross BlueShield Claims InstructionsBlueCross BlueShield Secondary Coverage Claims InstructionsSummaryInternet LinksReviewChapter 14: MedicareChapter OutlineChapter ObjectivesKey TermsIntroductionMedicare Eligibility and EnrollmentMedicare CoverageMedicare Participating, Nonparticipating, and Opt-Out ProvidersAdvance Beneficiary Notice of NoncoverageMedicare as Primary and Secondary PayerMedicare Summary NoticeMedicare Billing NotesMedicare Claims InstructionsMedicare and Medigap Claims InstructionsMedicare-Medicaid (Medi-Medi) Crossover Claims InstructionsMedicare as Secondary Payer Claims InstructionsMedicare Roster Billing for Mass Vaccination Programs Claims InstructionsSummaryInternet LinksReviewChapter 15: MedicaidChapter OutlineChapter ObjectivesKey TermsIntroductionMedicaid EligibilityMedicaid CoverageMedicaid ReimbursementMedicaid Billing NotesMedicaid Claims InstructionsMedicaid as Secondary Payer Claims InstructionsMedicaid Mother/Baby Claims InstructionsCHIP Claims InstructionsSummaryInternet LinksReviewChapter 16: TRICAREChapter OutlineChapter ObjectivesKey TermsIntroductionTRICARE HistoryTRICARE AdministrationCHAMPVATRICARE CoverageTRICARE Billing NotesTRICARE Claims InstructionsTRICARE as Secondary Payer Claims InstructionsTRICARE and Supplemental Coverage Claims InstructionsSummaryInternet LinksReviewChapter 17: Workers’ CompensationChapter OutlineChapter ObjectivesKey TermsIntroductionFederal and State Workers’ Compensation ProgramsEligibility for Workers’ Compensation CoverageClassification and Billing of Workers’ Compensation CasesWorkers’ Compensation and Managed CareForms and ReportsAppeals and AdjudicationFraud and AbuseWorkers’ Compensation Billing NotesWorkers’ Compensation Claims InstructionsSummaryInternet LinksReviewAppendix I: FormsAppendix II: Dental Claims ProcessingAppendix III: AbbreviationsBibliographyGlossaryIndex
